Hydrotherapy

Hydrotherapy

Hydrotherapy, formerly called hydropathy, involves the use of water for pain-relief and treating illness. The term hydrotherapy itself is synonymous with the term water cure as it was originally marketed by practitioners and promoters in the 19th century. A hydrotherapist therefore, is someone who practices hydrotherapy.

Water cure has since come to have two opposing definitions, which can cause confusion.

(a) Water cure therapy  – a course of medical treatment by hydrotherapy

(b) water cure torture  – a form of torture in which a person is forced to drink large quantities of water.[1]

The sense used in this article is the first one, synonymous with the term hydrotherapy, and which precedes recorded use of the second sense.[a]

Hydrotherapy in general encompases a range of approaches and their definitions. These range from approaches and definitions which are either naturally distinct, or made so for marketing purposes, to approaches and definitions which overlap significantly, and which can be difficult to disentangle.

One such overlap pertains to spas. According to the International SPA Association (ISPA), hydrotherapy has long been a staple in European spas. It is the generic term for water therapies using jets, underwater massage and mineral baths (e.g. balneotherapy, Iodine-Grine therapy, Kneipp treatments, Scotch hose, Swiss shower, thalassotherapy) and others. It also can mean a whirlpool bath, hot Roman bath, hot tub, Jacuzzi, cold plunge and mineral bath. These treatments use physical water properties, such as temperature and pressure, for therapeutic purposes, to stimulate blood circulation and treat the symptoms of certain diseases.[

Hydrotherapeutic mechanisms and modern medicine

Modern medicine's successes, particularly with drug therapy, removed or replaced many water-related therapies during the mid-20th century. Nowadays, water therapy may be restricted to use in physical therapy, and as a cleansing agent. However, it is also used as a medium for delivery of heat and cold to the body, which has long been the basis for its application.

Hydrotherapy involves a range of methods and techniques, many of which use water as a medium to facilitate thermoregulatory reactions for therapeutic benefit. While the physiological mechanisms were initially poorly understood, the therapeutic benefits have long been recognised, even if the reason for the therapeutic benefit was in dispute. For example, in November 1881, the British Medical Journal noted that hydropathy was a specific instance, or "particular case", of general principles of thermodynamics. That is, "the application of heat and cold in general", as it applies to physiology, mediated by hydropathy. In 1883, another writer stated "Not, be it observed, that hydropathy is a water treatment after all, but that water is the medium for the application of heat and cold to the body". Thus, the "active agents in the treatment (are) heat and cold", of which water is little more than the vehicle, and not the only one".

With improved knowledge of physiological mechanisms, practitioners wrote specifically of the use of hot and cold applications to produce "profound reflex effects", including vasodilation and vasoconstriction. These cause changes in blood flow and associated metabolic functions, via physiological mechanisms, including those of thermoregulation, that are these days fairly well understood, and which underpin the contemporary use of hydrotherapy. Although standard anatomy and physiology textbooks make only passing reference, if any, to hydrotherapy, some of the best descriptions of the underlying physiology upon which hydrotherapy relies, are to be found in such textbooks. For example, one of the best succinct descriptions of blood redistribution (which is fundamental to the above-mentioned reflex reaction), quoted below, is from a standard textbook.

...by constricting or dilating arterioles in specific areas of the body, such as skeletal muscles, the skin, and the abdominal region, it is possible not only to regulate the blood pressure but also to alter the distribution of blood in various parts of the body.

British and other hydrotherapy establishments are discussed from another standpoint in a recent history of psychiatry.

Acupuncture treatment good for shoulder-hand syndrome

Source: http://www.ncbi.nlm.nih.gov/pubmed/22574575

Abstract

OBJECTIVE:

To assess the effectiveness of acupuncture therapy for shoulder-hand syndrome.

METHODS:

According to the requirements of evidence-based medicine, papers of randomized controlled clinical trials for shoulder-hand syndrome published in China from 2005 to 2010 collected by databases VIP, Wanfang, CNKI, collections of papers of academic conferences, etc. were retrieved by using key words of shoulder-hand syndrome, reflex sympathetic dystrophy, acupuncture, moxibustion. Then the collected documents were given with Jaded score, and analyzed by using software Manager 5. 0 Review Cochrane.

RESULTS:

A total of 100 papers were retrieved. Among them, 29 papers that met our inclusion criteria were given with Jaded scores (2 points for 2 papers, 1 point for the rest 27 papers, being low in quality). Twenty-one papers were brought into Meta analysis. These papers contain 1 768 cases of patients who were divided into three sets of groups according to the used intervention measures. Meta-analysis showed that simple acupuncture therapy is significantly superior to acupoint block therapy for relieving shoulder-hand syndrome [odds ratio (OR, 95% CI) 4.80 (2.02 to 11.41), P < 0.05]; electroacupuncture therapy is markedly more effective than simple acupuncture therapy [OR (95% CI) 4.60 (2.08 to 10. 17), P < 0.05]; and acu-moxibustion combined with other therapies is significantly more effective than simple acupuncture therapy [OR (95% CI) 3.31 (2. 30 to 4.77), P < 0.05]. The other 8 papers were not brought into Meta-analysis due to being different to the 21 papers in the intervention measures.

CONCLUSION:

Acupuncture can effectively relieve shoulder-hand syndrome in pain, wrist- and shoulder-joint motor, etc. But, larger size of samples and high quality randomized clinical trials are needed for providing more reliable conclusive evidence.

Acupuncture in Physiotherapy

Background

Acupuncture may be offered to you as part of your rehabilitation and pain management programme. Acupuncture is one of a number of different types of treatment that the physiotherapist can offer and there is good evidence for its effectiveness. Often a physiotherapist will use acupuncture alongside treatments such as exercise, joint manipulation/mobilisation and general rehabilitation.
Acupuncture is viewed by physiotherapists as a complementary rather than an alternative therapy

What is Acupuncture?

Traditional Chinese Medicine (TCM) acupuncture (which can be traced back as far as 1000BC) developed out of a concept of using needles inserted into the body as a means of balancing the movement and level of 'Qi' (energy life force) within the body – an imbalance of Qi leading to disease, pain or disability.
Recent research is now supporting the effectiveness of acupuncture, particularly in the management of pain, suggesting that it is effective in the treatment of low back pain, neck pain, and knee/hip osteoarthritis.
Acupuncture combined with physiotherapy is now widely accepted within the NHS and private practice.

When Should it Not Be Used?

There are certain circumstances where acupuncture should not be used.

•  If you have a known metal allergy, specifically stainless steel

•  If you have a needle phobia

•  If you have a known infection in the area to be needled

When Should it Be Used With Caution?

You should also inform your physiotherapist if you:

•  Have haemophilia

•  You are pregnant or trying to conceive

•  Suffer from epilepsy

•  Have a deficient/weakened immune system

•  Have a heart pace maker

•  Are taking anticoagulation (blood thinning medication)

•  Are Diabetic

These conditions do not exclude you from having acupuncture but they will influence its application. Your Physiotherapists needs to know.

Does Acupuncture Work?

Yes, but it does not work for all. Success can depend on a number of factors, which include:

•  General health

•  The severity and duration of the condition

•  How the condition has been managed in the past

No two people are the same and it is one of the strengths of acupuncture that we treat people individually to get better results. If you know someone who has experienced acupuncture you may find it helpful to discuss the process before deciding on treatment.

What does Acupuncture Treatment Involve?

Your Physiotherapist will use sterile, single use needles. The needles are fine (a lot finer than an injection needle) and they are inserted quickly through the skin and into the tissues. Acupuncture needling should not be painful although some people do report experience a pinprick or scratch like sensation.
Once the needles are in place you may feel a mild ache, numbness, warm or heavy sensation at and around the needle. This should not be unpleasant. This is referred to as 'De Qi' and is a sign that the body’s inbuilt pain relieving mechanisms are being stimulated.

How Many Needles Will Be Used?

Most commonly a treatment will involve the insertion of between 2-16 needles.

Needle Stimulation?

Once the needles are in place your physiotherapist may gently stimulate the needle until you experience the De Qi. This may be repeated again throughout the treatment.
Needles can also be stimulated using electrical impulses. This is called electro- acupuncture. Here needles are coupled to a battery-operated machine. This causes a tingling sensation to be felt at the site of the needle. Low Frequency impulses can help reduce longstanding chronic pain whilst higher frequency impulses can be more helpful in managing acute pain and muscle spasm.

How Long are The Needles In For?

Needles can be in place for as little as a few seconds or 1-2 minutes. More commonly needles will be in place for between 10-30 minutes.

Where Will The Needles Be Placed?

Needles may be inserted:

•  Around the painful area

•  Away from it (hands or feet)

•  On the opposite side of the body

Recent research suggests that needling away from an area of pain is effective. This can be particularly useful if you feel the painful area is too sensitive.

How Many Treatments Are Needed?

Research suggests that for a longstanding condition such as low back pain, a course of 6 – 10 treatments is required to achieve the best results. If after further assessment/ treatments your symptoms remain the same, it is unlikely that acupuncture will help you. If you do respond positively to acupuncture the period of symptom ease is varied and uncertain. Some people experience lasting relief of symptoms especially when used to manage a recent acute problem. Your physiotherapist will discuss your individual management plan. Acupuncture treatments may vary dependent on the condition being treated and how you respond to treatment. Each treatment should be tailor-made to you and your condition.

Is It Safe?

Members of the Acupuncture Association of Chartered Physiotherapists (AACP) are required to train to a minimum standard and are bound by professional codes of conduct through the Chartered Society of Physiotherapy (CSP) and Health Professions Council (HPC). 
Acupuncture is safer than many of the drug treatments used. However, any procedure that involves inserting needles into the body has some potential problems, but these remain minimal. Acupuncture has been known to produce some ‘side effects’ in certain people.

Minor Side Effects:

•  Some discomfort at needle site

•  Drowsiness and sleepiness following treatment

•  Bruising at the needle site

•  Temporary pain increase

•  Fainting

•  Feeling faint

Introduction To Acupuncture

Acupuncture is a form of ancient Chinese medicine in which fine needles are inserted into the skin at certain points on the body.

It is a complementary or alternative medicine (CAM). This means that acupuncture is different in important ways from treatments that are part of conventional western medicine. Unlike conventional treatments, the use of acupuncture is not always based on scientific evidence.

Theory

Acupuncture is based on the belief that an energy, or 'life force', flows through the body in channels called meridians. This life force is known as Qi (pronounced 'chee'). Practitioners who adhere to traditional beliefs about acupuncture believe that when Qi cannot flow freely through the body, this can cause illness. They also believe that acupuncture can restore the flow of Qi, and so restore health.

Uses

Practitioners – called acupuncturists – use acupuncture to treat a wide range of health conditions. It is often used to treat pain conditions such as headache, lower back pain and dental pain, but is also commonly used against conditions ranging from infertility to anxiety and asthma. To learn more, see Common uses of acupuncture.

The availability of acupuncture on the NHS is limited (see box, left). Most acupuncture patients pay for private treatment.

Does it work?

There is some evidence that acupuncture works for a small number of conditions, including migraine and post-operative nausea. However, there is little or no scientific evidence that acupuncture works for many of the conditions for which it is often used. More scientific research is needed to establish whether acupuncture is effective against these and other conditions.

There is no scientific evidence for the existence of Qi or meridians. Some scientists and acupuncturists believe that acupuncture may stimulate nerves and muscle tissue, and that this may be responsible for the beneficial effects that have been observed in some scientific trials. More research is needed before acupuncture’s method of action is fully understood.

For more information, see Evidence for acupuncture. If you choose to have acupuncture, make sure that your acupuncturist is fully qualified and practises the treatment under safe and hygienic conditions.

Currently, the National Institute for Health and Clinical Excellence (NICE) recommends acupuncture as a treatment option only for lower back pain. Read the NICE 2009 guidelines on l

Older people back exercise classes aiming to reduce falls

Older people back exercise classes aiming to reduce falls

Falls prevention exercise classes are beneficial for older people, according to a report published this week by the Royal College of Physicians (RCP).

The delivery of evidence-based exercise classes varies widely between healthcare providers, and many patients need to be made more aware that therapeutic exercise can help to prevent falls, researchers found.

The RCP report is based on feedback from more than 1,700 older people who attended NHS-run exercise programs that aimed to reduce falls.

The results showed that 96 per cent of older people felt the exercises were beneficial, while 95 per cent were either satisfied or very satisfied with their exercise program.

Physiotherapist Jill Phipps, falls prevention coordinator at Southern Health NHS Foundation Trust welcomed the report. She was a member of the Fall Safe steering group, a project led by the RCP which promoted best practice in the prevention and management of falls in hospital wards.

Strength and balance

She said the results showed that Physio should be striving to raise awareness of how strength and balance exercises can promote healthy ageing, as well as ensuring that they adhere to the evidence base for exercise.

‘We are delighted that older people enjoy their NHS exercise class and find it beneficial,’ said Ms. Phipps.

‘Physios enjoy taking the classes and we’d like to do more. But as the report says there is still work to be done in raising awareness of the evidence base, and the fact that exercise is more cost effective than any other intervention for falls prevention. Exercising in groups also provides an opportunity for social interaction.’

To download the report, see the website link below.

WEBSITE LINKS

Royal College of Physicians report

Physiotherapy works: Fragility, fractures and falls

Physiotherapy and clinical Pilates

Physiotherapy and clinical Pilates

The last decade has seen a growing body of research supporting proximal stabilisation for management of spinal injuries. Poor control and lack of endurance of trunk musculature are associated with low back pain. Researchers have developed a range of criteria for training "core control".

With the focus now on control of muscle rather than strength a "new" approach had to be taken to meet the criteria.

The Pilates (Pi-lart-ees) system of exercise been popular amongst performers for many years. With a basis of submaximal /variable resistance work in potentially unstable positions it had many of the right ingredients to satisfy stability training criteria. The exercises can encourage efficiency and submaximal muscle control by using variable (i.e. spring loaded) resistance and movement. To execute the exercises properly a stable, controlled pelvic and shoulder girdle is established with load facilitating both deep and global stability musculature.

Clinical Pilates description



The Clinical Pilates program has been developed by Australian physiotherapist Craig Phillips since 1990 to develop training of functional stability by progressing static stability into dynamic. Drawing on the original work of Joseph Pilates the program needed refinement to improve safety and highlight the components valid in stability training and injury diagnosis and management.

Developed specifically as a treatment tool for physiotherapists, Clinical Pilates is unique as a tool for establishing differential diagnoses, identification of radiological false positives / false negatives, establishment of outcome predictors  and  application of pathology specific exercise programs. 

DMA Clinical Pilates is the first to use real time ultrasound to determine if muscle activation patterns are being achieved. As a result changes had to be made to the traditional Pilates approach as a predominance of "bracing" activity was being consistently noted instead of appropriately sequenced, controlled tonic activity of the deep stabilisers.

Movement dysfunction often leads to pathology and vice versa. Low level Type 1 endurance musculature is the primary focus of stability training, and the aim is for early onset, at low loads, of both the local / deep stabilisers such as transversus abdominus and the deep multifidus and the more superficial global stabilisers such as the oblique / superficial multifidus, latdorsi etc. The difficulty in getting patients to activate stability musculature is because low % maximum voluntary contraction (MVC) required for stability and postural control is not as easy to "feel" as higher % MVC.

Therefore the exercises must facilitate and challenge those muscles irrespective of whether the patient is consciously aware of the muscle activity or not. If the muscle is to act as a background to movement it stands to reason that it should then be trained in the background and a "movement pattern" developed .Stability training must progress from the static to the dynamic and incorporate the connection between the shoulder and pelvic girdles. Static isolated muscle activity does not guarantee carry over into the dynamic situation. Load and movement are key factors in muscle activity so "if you want a muscle to do a job it must have a job to do" and it must be appropriate.

Injury management with clinical Pilates

An important issue in stability training is the effect of pathology. Pathologies are generally load sensitive as well as direction sensitive. Therefore if a pain producing pathology exists it must be determined if it has a direction preference. The neutral position required for ideal posture may in fact be provocative in the initial stages leading to pain, hence, muscle inhibition. Unloading the pathology in either flexion, extension or off center may well protect the pathology and allow muscle activity to occur. With progression, neutral is incorporated and eventually the provocative position used to determine the "threshold of function" of the injury.

As the research and knowledge develops in this area it is encouraging to know that the CLINICAL PILATES program can be "tuned" to both satisfy the guidelines of the researchers and meet the needs of the clinician.

Exercise Ball Safety: Do’s and Don’ts For Safe Exercise Ball Use

Exercise Ball Safety: Do’s and Don’ts For Safe Exercise Ball Use

DO’S:

•  Use only high quality burst resistance exercise balls (DuraBall Pro or Similar) that display an inflation date that is less then 12 months old.

•   Inspect the ball before each use, look for gouges, cracks, peeling or under inflation

•  Exercise on a padded floor or mat

•  Use a spotter and extreme caution when using resistance equipment with an exercise ball**

•   Replace balls every 12 months or at the first sign of wear; especially in high use facilities

•  New exercise balls should be inflated as per instructions and clearly labeled with the inflation date (Month / Year) in permanent ink

DON’TS

•    Use a ball with visible signs of wear

•  Patch or plug a damaged or leaking ball

•   Inflate larger then the recommended size

•   Store balls near sharp metal or heat sources

•   Kick an exercise ball

BE SMART – BE ON THE BALL

** Use of resistance equipment such as bar/dumbbells while on a ball is not recommended as it dramatically increases the risk of serious injury