Physical Effects and Physical Effects and Medical Efficacy Medical Efficacy

in Medical Hydrology and in Medical Hydrology and HydrotherapyHydrotherapy

Physical effects of bathingPhysical effects of bathing

Mechanical effectsThermal effects

Mechanical effects of waterMechanical effects of water

Buoyancy Hydrostatic pressure (immersion) Viscosity

Effect of buoyancyEffect of buoyancy

RelaxationDecrease of muscle tension

Effect by immersionEffect by immersionEffect by immersionEffect by immersionHalf bathHalf bath Full bathFull bath

About 1000 ml of blood flows into the thoraxAbout 1000 ml of blood flows into the thorax

Air bathAir bath

Acute effects of immersionAcute effects of immersionAcute effects of immersionAcute effects of immersion

in haemo dynamic functionin lung functionin kidney functionin neuro-muscular functionin endocrine functionto the blood

Effect of immersionEffect of immersion

Heart rateHeart rate

Blood pressure

Blood pressure

DivingEffect of stand up

Effect in haemodynamic functionEffect in haemodynamic function

Increase of the central hypervolaemia Increase of the stroke volume and cardiac minute output Decrease of the heart rate Often decrease of the systolic blood pressure Increase of the central venous and pulmonary blood pressure Decrease of the peripheral resistance Decrease of the peripheral venous tonus and orthostatic

tolerance

Effect in lung functionEffect in lung function

Decrease of the vital capacity and functional residual capacity

Increase of the expiration resistanceDecrease of the expiration reserve volumeIncrease of the alveolar-arterial oxygen

differenceDecrease of the arterial oxygen pressure

Immersion effect in creatine clearanceImmersion effect in creatine clearance

Effect in kidney functionEffect in kidney function

Increase of the diuresis Increase of the natriuresis Increase of the kaliuresis Increase of the glomerular filtration Increase of the osmotic clearance Increase of the water-clearance Increase of the PAH-clearance (para-aminohippuric

acid)

Effect in neuro muscular functionEffect in neuro muscular function

Increase of the muscle relaxationDecrease of the reflective contractionIncrease of the mobilityDecrease of the oxygen consumption

Effect in endocrine functionEffect in endocrine function

Stimulation of the atrio-natriuretic factors (ANF) Suppression of renin, angiotensin, aldosterone,

epinephrine, nephrine Suppression of ACTH and cortisone Suppression of adiuretine (ADH) and prolactin Stimulation of the endogenous dopaminergic and

central opioid activity (ß-endorphins)

Effect to the bloodEffect to the blood

Change of haematocrit (first de- than increase)Change of plasma volume (first in- than decrease)Change of plasma viscosity (first de- than increase)

The bath diuresisThe bath diuresisThe bath diuresisThe bath diuresis

Peripheral liquid changePeripheral liquid change Renal effectsRenal effects

ImmersionImmersionDecrease of transmural pressure Decrease of transmural pressure

Increase of capillary re-absorptionIncrease of capillary re-absorption

Increase of plasma volumeIncrease of plasma volume

Central hypervolaemiaCentral hypervolaemia

Increase of ANFDecrease of ADH and RAAS

change of renal dynamic

Increase of ANFDecrease of ADH and RAAS

change of renal dynamic

Increase of diuresisnatriuresis etc.

Increase of diuresisnatriuresis etc.

IndicationsIndicationsof thermoneutral bathsof thermoneutral baths

Muscle relaxation and join relief– rheumatic diseases

Relaxant effect by sympaticolysis, suppression of stress hormones and muscle relaxation– Psycho-vegetative syndrome– Psycho-physical overloading– Convalescence

Indications Indications of thermoneutral bathof thermoneutral bath

Dehydration effect by improved capillary re-absorption and diuresis– Rheumatic diseases– Posttraumatic and postoperative state– Oedema

Training of vegetative-hormonal functions like blood volume-, blood pressure- and electrolyte regulation– Convalescence– Heart-circulation-regulation disturbance– Psycho-vegetative syndrome

Perception of thermal effects in Perception of thermal effects in waterwater

Cold: lesser than 32 °C Thermoneutral: 34-35 °C Warm: till 38 °C Hot: more than 38 °C

Effect of cold bathingEffect of cold bathing

Thermal stimuli for training of blood flow regulation – Functional disturbance of blood flow– Phlebopathy– Cardio vascular diseases

Thermal stimuli for training of inurity– Infect prophylaxis

Effect of cold bath on epinephrineEffect of cold bath on epinephrineby Bühringby Bühring

NephrineNephrine

0

200

400

600ng/l

1535

36,5

37oC

oC

0 10 20 30 40 50 60 70 min.Before

15 oCErwärmung bis 1 oC unter Rektaltemperatur

Water temperatureWater temperature

Body temperatureBody temperature

EpinephrineEpinephrine

Hormonal reactions by coldnessHormonal reactions by coldness

Local hyperaemia is a reaction of acetylcholine release. By cholinesterase no systemic effect results.

The consensual reaction results by release of nephrine and epinephrine, and the effect by circulation reaction.

The reactive hyperaemia results by release of histamine and inhibition of the cholinesterase in case of well supplied tissue with blood. The acetylcholine-hyperaemia period is longer. To get this reaction the cold stimulation should be not very strong.

Rules of coldness applicationRules of coldness application

Before application the hole body has to be comfortable warm.

The cold stimulation has to be short and strong.After application the body has to be mobilised

to warm up again,Between the applications a break of 2 to 3 hours

will be needed.

Cold sensitivityCold sensitivity

In the morning stronger than in the afternoon.In summer stronger than in the winter.By great difference of temperature stronger than

by slowly warming up.On big areas stronger than on smaller areas.In long-time contact stronger than in short-time.

Effect of changing cold-hot bathingEffect of changing cold-hot bathing

Thermal stimuli for training of vegetative-hormonal functions– Convalescence– Psycho-vegetative syndrome– Cardio vascular regulation disturbance– Metabolic disorders

Effect of hot bathingEffect of hot bathing

Muscle relaxation Increase of extensibility the structures of

connective tissue Analgesic Anti-inflammatory by overheating

– Rheumatic diseases– chronic-inflammatory diseases of the urogenital

system– Post acute after trauma conditions and operations on

locomotor system

Effect of hot bath on blood circulationEffect of hot bath on blood circulation by Barcroftby Barcroft

45

40

35

30

25

oC

0 10 20 30 40 50 60 70 80 90 100 110 120 min.

80

60

40

100

%Blood circulation in musclesBlood circulation in muscles

Water temperatureWater temperature

Heart rate in hot bathsHeart rate in hot baths

Heart rateHeart rate

Temperature of water

Temperature of water

Respiratory minute volume

Respiratory minute volume

Heat-transferHeat-transfer

Moving water: Convection– Quickly heat transfer

(stronger temperature sensitivity)

Not moved water or mud: Conduction– Slowly heat transfer (lower temperature

sensitivity)

Heart rate by coldness shockHeart rate by coldness shockDiving after Sauna in cold waterDiving after Sauna in cold water

Blood pressureBlood pressure

Increase of heart rate

Increase of heart rate

SaunaSauna ControlControl

Inure effect by stimulation of stress-proteinsInure effect by stimulation of stress-proteins

Stress-proteins are produced by– Heat shock– Environment stressors– Heavy metals– Inhibitors of the energy metabolism– Amino acids– Chemotherapeutica

Inure effect by stimulation of stress-proteinsInure effect by stimulation of stress-proteins

Stress-proteins are produced by– Normal cell grow– Cell division– Grow factors– Cell differentiation

Inure effect by stimulation of stress-proteinsInure effect by stimulation of stress-proteins

Stress-proteins are produced by– Diseases– Virus infections– Fever– Inflammations– Circulation disturbances– Hypertrophy– Oxidation– Cancer

Inure effect by stimulation of stress-proteinsInure effect by stimulation of stress-proteins

Stress proteins have chaperone and inure effects– in oxygen deficiency situations,– in defence of virus-infections,– in stimulation of the immune system,– in protection of endogenous proteins.

Risk of bathingRisk of bathing During immersion:

increased cardiac preload results in a decompensation riskBe careful by Cardiac rhythm disturbance and

Angina pectoris After immersion:

collapse trendBe careful by Venous disease and

orthostatic irregularity During bathing:

burdening of the respiratory and lung functionBe careful by respiratory insufficiency

Contra indications in bathingContra indications in bathingContra indications in bathingContra indications in bathing

Strong febrile and infective diseasesHeart-insufficiency stage III and IV (NYHA)Hypertension stage III (WHO)Acute skin diseases and large skin lesions

Hydrotherapeutic measuresHydrotherapeutic measures

WashingsAffusionsBathsWater steppingBrushingsPacks and wraps

Holding the tube to prove the Holding the tube to prove the water pressure for affusionswater pressure for affusions

Knee-affusionKnee-affusion

Arm-affusionArm-affusion

Over-affusionOver-affusion

Flash-affusionFlash-affusion

Upper part washingUpper part washing

Lower part washingLower part washing

Putting a wrapPutting a wrap

Breast-wrapBreast-wrap

Arm-wrapArm-wrap

Wet-socksWet-socks

Lumbar wrapLumbar wrap

Hay-sackHay-sack

Loam-packLoam-pack

Half-bathHalf-bath

Seat-bathSeat-bath

Foot-bathFoot-bath

Arm-bathArm-bath

Steam-bathSteam-bath

Water steppingWater stepping

Hydrotherapy in cardiac-circulation Hydrotherapy in cardiac-circulation problemsproblems

Functional tachycardia:– Cold compress, cold hand- or arm bath till 1 min., hand

joints 2 minutes under coldwater valve

Bradycardia:– Warm arm bath rising from 36 to 39 °C

Cramp in the leg:– Soft warm (37 °C) and cool (20-22 °C) changing washings

or affusions

Hydrotherapy in respiratory Hydrotherapy in respiratory problemsproblems

Strong cough:– Arm- or foot-bath rising from 35 to 40 °C

High fever (Pneumonia):– Cool breast-washings or -wraps

High fever (Infection):– Cool to cold serial washings (right and left leg, abdomen)

without wipe dry in the bed, repeated every 30 min.

Hydrotherapy in neuralgiaHydrotherapy in neuralgia

Acute sciatica:– cold compress to the lumbar region

Chronic sciatica :– warm-hot compress

Shoulder-arm-neck-pain:– hot compress, soft massage, neck roll

Sleep disturbance:– In bed cool washings and calf-wrap

Hydrotherapy in disturbancesHydrotherapy in disturbances of the abdomen of the abdomen

Colic without fever:– Hot packs

Kidney-bladder-colic:– Rising hot foot-bath or seat-bath

Conclusion in hydrotherapyConclusion in hydrotherapy Improvement of macro- and

microcirculation Improvement of cardiac output Improvement of oxygen supply Vegetative normalisation, stabilisation General inurity Improvement of the physical efficiency Stimulation of the stomach secretion Increase of the central excitability Increase of IgM-, a2-macro-globulin-,

complement C3-concentration