Rehabilitation in water and Hydrotherapy: Benefits
Hydrotherapy and rehabilitation in the water have been part of the rehabilitation protocols in the orthopedic and sports field for a few years.
Hydrotherapy is indicated both as a means of physical preparation for surgery and as an effective rehabilitation tool in the post-operative re-education phase. In the latter case, water rehabilitation usually begins after desuturation representing a very important treatment when traditional exercises are contraindicated.
Even if rehabilitation programs are often limited to making the patient perform exercises very similar to those performed in the gym, to set up a correct rehabilitation program in water it is necessary to know some very important principles, such as buoyancy, viscosity and pressure. hydrostatic. This knowledge will then be integrated with each other and adapted to the patient's problems and the goals of the therapeutic program.
PHYSICAL PRINCIPLES
Archimedes' Principle : a body immersed in a liquid receives a hydrostatic thrust from the bottom upwards equal to the weight of the liquid displaced. Consequently when we dive to the navel our weight is apparently reduced by about 50% to decrease up to 90% when the dive reaches the shoulders.
This push allows you to resume the walking exercises first by lightening the weight on the joints and improving the circulation of the cartilage tissue. In water there is less activation of the receptors that control postural tone, in the spinal muscles there is a reduction in tension from 1.8 kg / cm² in air to 0.79 kg / cm². Thanks to this principle we can recover the motor pattern of the journey earlier than can be done in the gym, obtaining a better and earlier rehabilitation movement.
Viscose reaction : it is the reaction that a liquid opposes to a body that moves inside it (resistance). Water is in fact denser than air and for this reason it provides greater resistance to movement. Thanks to this principle we can strengthen the muscles without using additional overloads and weights. This resistance increases as the speed of the movements increases and the surface of the body segment we want to move. For this reason, if we hold objects with larger or smaller surfaces in our hands, with the same density, we can modulate the difficulty of the exercise to our liking.
Hydrostatic pressure : depends on the water level (increases with increasing depth). This pressure is exerted perpendicularly at each point of the body surface, improving balance and proprioception (ability to regulate posture thanks to the coordination of a motor response adequate to external variations). It is not by chance that proprioceptive training is one of the most important aspects of rehabilitation. The hydrostatic pressure also makes water an excellent means of aerobic conditioning, improving the efficiency of the digestive (especially renal), respiratory and cardiovascular systems.
Temperature: heat increases tissue vascularization thanks to the direct and indirect stimulation of vasodilation. Usually the water in the rehabilitation tanks is kept at a slightly higher temperature (31-35 ° C) than in traditional pools. This makes it possible to take full advantage of the vasodilating properties of the heat which improves tissue oxygenation, favoring muscle recovery even from chronic irritation conditions such as low back pain (thanks to the combined action of heat and hydrostatic pressure the blood flow to the muscle increases in fact by 225% when diving up to the neck). The water temperature should always be maintained at these temperatures to avoid the risk of possible heart attacks in predisposed subjects.
REHABILITATION IN WATER: aquatic weight in relation to the level of immersion | |
| WATER HEIGHT | AQUATIC WEIGHT |
| Total immersion | 3% of the earth's weight |
Up to the neck | 7% of the earth's weight |
| Behind | 20% of the earth's weight |
| On the chest | 33% of the earth's weight |
| navel | 50% of the earth's weight |
| At the basin | 66% of the earth's weight |
| Mid-thigh | 80% of the earth's weight |
| In the calf | 95% of the earth's weight |
Main advantages of water rehabilitation
- The decrease in the force of gravity, makes the movements more natural and less stressful for the joints allowing the execution of movements unthinkable to dry.
- The resistance offered by the water is gradual, without dead spots; this allows to maintain a uniform muscular tension during the movements favoring the recovery of tone and muscular flexibility.
- To be able to perform rehabilitation exercises it is not necessary to be an expert swimmer. In tanks intended for rehabilitation the water level normally does not exceed 120 cm and there are still small tools to help float.
Set up a water rehabilitation program
The rehabilitation program will be set up following a careful assessment of the patient's needs and the goals set.
In principle, re-education in water, like many other sports and rehabilitation activities, consists of two or three weekly sessions for a variable period in relation to the degree of individual disability.
TECHNIQUES AND EXERCISES
Rehabilitation in water consists in having the patient perform various exercises, many times the same ones that are performed in the gym, with the body partially immersed in water. By dividing these exercises into four broad categories, we can talk about exercises aimed at improvement:
muscle tone (open kinetic chain exercises, eccentric or concentric)
of joint mobility and balance (stretching exercises, active / passive mobilization exercises, proprioceptive exercises)
and to the recovery of motor patterns (gait / suspension travel, pedaling, leaps, jumps etc.)
and the recovery of the sporting gesture (kinetic chain exercises closed in shallow water, leaps, skips, lunges, lateral movements etc.
To increase the difficulty of the movements, as we have seen, it will be sufficient to increase their amplitude, speed or use equipment that creates resistance. You can also play on the degree of depth of the water by decreasing it as the patient regains lost functionality by tolerating higher loads.
OPEN AND CLOSED KINETIC CHAIN EXERCISES: open kinetic chain exercises such as leg extension are usually performed with the body segment completely immersed in water. These exercises allow you to selectively strengthen a single muscle group and improve the mobility of a single joint. For this reason they are usually used in the initial phases of the rehabilitation program.
The closed kinetic chain exercises, usually carried out in shallow water, make several muscle groups and joints work simultaneously, keeping the distal ends (usually the feet) resting on the bottom of the pool. Examples of closed kinetic chain exercises are bending on the legs and lunges. This type of exercise, being not very specific and quite demanding, is used only in the final phases of movement re-education or sports activities.
REHABILITATION IN WATER AFTER DISTORTION OF THE ANKLE
Proprioceptive re-education; the patient is invited to walk along the tank keeping a floating board under the foot in order to create a situation of continuous instability during the various phases of the step.
Muscular reinforcement; exercises with the step, flexion-extension of the legs with the support of a float, freestyle swimming with the fins so as to increase the resistance of the water, walk with tools that increase the resistance of the water in the specific of the gesture and movements adduction, abduction and flexion-extension of the leg from a standing position.
Gesture Recovery; we are going to perform various types of walking, forward, backward, sideways, running in the three directions, jumps, jumps and all the other situations that you can go against when returning to the patient's activity. All these exercises can undergo variations such as, for example on the way, walking forward before exacerbating the bending of the knee almost touching the abdominal area, or keeping the legs stiff.
REHABILITATION IN WATER AFTER INTERRUPTION OF THE CRUSHED HOOK
A typical pool seat includes an initial phase with a heating system that includes the pool pendulum and exercises for the hip muscles. The next exercise uses a floating tube to imitate the movement of the bicycle. Knee extension movements and preparatory exercises for the load are performed. The task of the therapist is to correct the gait, the gaits, the beats of the legs with the help of the tablet, the run on the spot or in suspension, triple extension with the lifebuoy, flexed extension of the knee before without then with fin, leaps, slips side, direction changes, swimming with short and long fins.
Therapy or rehabilitation?
Rehabilitation in the water is part of the largest family of aquatic therapies. In water, in fact, it is possible not only to restore the best joint and muscle functions after an accident, but also to perform specific forms of exercise to prevent the disease or to treat chronic idiopathic symptoms such as low back pain. These exercises are particularly suitable for those who are severely overweight with movement difficulties related to obesity, arthritis, recent fractures or sprains. In most of these cases there is a clear improvement in muscle tone and joint range after an adequate therapeutic program. The patient, often elderly, thus acquires a greater motor control which, by improving the balance, removes the risk of falls and slows down the functional decline linked to aging.
If used correctly, aquatic therapy is also a very effective tool for completing the normal workouts of athletes who can thus avoid overtraining injuries. In these cases the water temperature should not exceed 28-30 ° C. Instead, the stretching routine is more effective if performed in the rehabilitation pool where the temperature reaches 32-35 ° C.
Contraindications
As we have seen, rehabilitation and aquatic therapy represent the ideal activity for many subjects. However in some cases the exercises in water can be contraindicated. This is the case, for example, of those who suffer from advanced diabetes, ischemic heart disease (especially if the water temperature is too cold), fever, incontinence, infections and cutaneous mycoses. In other situations, for example for patients suffering from advanced osteoporosis, it is instead advisable to keep the traditional forms of exercise out of the water. For all these reasons, it is a good idea to consult a doctor before starting a therapeutic water program.
| INDICATIONS | CONTRAINDICATIONS |
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