A CASE

FOR HYDROTHERAPY IN SPORT

This article presents the case for using hydrotherapy in sport in three different dimensions: treatment of sport injuries, maintenance of fitness during rehabilitation from injury, and prevention of sport injuries.

BY ALISON SKINNER, MCSP

INTRODUCTION The use of exercise in water as a treatment modality is available to everyone with access to a pool. In addition to public facilities provided by local councils, an increasing number of private health clubs and the major fitness chains have pools or large hot tubs. The properties of water – pressure, buoyancy, turbulence and warmth – can be used to create rehabilitation programmes to suit any stage of healing, but particularly the early stage. Activities can be functional, be sports-specific and, if the facility allows, include the use of sporting equipment.

TREATMENT OF SPORT INJURIES Following injury, treatment can begin in the pool earlier than on land as a result of the warmth of the water and the weight relief from the effect of buoyancy, which produce relief of pain and reduction of muscle spasm and thereby facilitate: n movement; n strengthening; n coordination; n functional recovery. According to Mano et al., sympathetic

nervous system activity is reduced in water; the deeper the water, the greater the effect. The relaxation gained will help to reduce muscle tone (1).

Hydrostatic pressure The hydrostatic pressure of the water

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produces a redistribution of interstitial fluid (2). This is equivalent to a double layer of Tubigrip on the lower leg. The hydrostatic pressure, which becomes greater as the depth of the water increases, therefore reduces swelling and effusion. This reduction of swelling is particularly effective for lower limb injuries, as there is increased lymphatic and venous return (3).

Buoyancy and turbulence Two physical properties of water, buoyancy and turbulence, can be used to strengthen muscles by finely graded and progressive exercise, ie. from buoyancy-assisted exercise, to buoyancy counterbalance and finally buoyancy- resisted exercise. Turbulence may be used to increase resistance and develop function or to re-educate balance. Exercises can be applied in functional patterns using the Bad Ragaz ring method, in which resistance is provided by turbulence and controlled by the athlete. This treatment method is based on three-dimensional diagonal movement patterns very similar to those of proprioceptive neuromuscular facilitation (PNF). It has the advantage of using the athlete’s perception of effort and discomfort to progress the exercise within their own control. Mobility of joints is facilitated

by activities where buoyancy is counterbalanced and the joints are relieved from stress and weight- bearing. This enables synovial sweep, which allows synovial fluid to be moved

over articular surfaces in order to restore nutrition to articular cartilage and promote healing. The exercises may be applied in a cyclical orientation, which ensures the compression and relaxation, both of which are needed to restore the normal structure of the articular cartilage. The weight relief of immersion facilitates gait re-education. The depth of the water is critical. For example, if the water is at C7 level for the athlete, then just 8% of their body weight is transmitted to the lower limbs (4).

Proprioception A number of athletic injuries require re-education of proprioception. The viscosity of the water may be utilised to facilitate proprioception by enabling slower three-dimensional movement enhanced by the creation of turbulence and support for balance. Athletes therefore have the time to perform movements in a balanced position, which facilitates accuracy and control. Activities such as standing on one leg while performing kicking movements with the other leg – important for a footballer, for example – can be started in the pool earlier than on land (5).

Functional rehabilitation Functional rehabilitation aims to ensure

EARLIER THAN ON LAND

INJURY TREATMENT CAN BEGIN IN THE POOL

sportEX dynamics 2009;20(Apr):18-19