Transcript Physical effects

Physical Effects and
Medical Efficacy
in Medical Hydrology and
Hydrotherapy
Physical effects of bathing

Mechanical effects
 Thermal effects
Mechanical effects of water

Buoyancy
 Hydrostatic pressure (immersion)
 Viscosity
Effect of buoyancy

Relaxation
 Decrease of muscle tension
Effect by immersion
Air bath
Half bath
Full bath
About 1000 ml of blood flows into the thorax
Acute effects of immersion

in haemo dynamic function
 in lung function
 in kidney function
 in neuro-muscular function
 in endocrine function
 to the blood
Effect of immersion
Effect of stand up
Heart rate
Blood
pressure
Diving
Effect in haemodynamic function
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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 function

Decrease of the vital capacity and functional
residual capacity
 Increase of the expiration resistance
 Decrease of the expiration reserve volume
 Increase of the alveolar-arterial oxygen
difference
 Decrease of the arterial oxygen pressure
Immersion effect in creatine clearance
Effect in kidney function
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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 (paraaminohippuric acid)
Effect in neuro muscular function
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Increase of the muscle relaxation
 Decrease of the reflective contraction
 Increase of the mobility
 Decrease of the oxygen consumption
Effect in endocrine function
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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 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 diuresis
Peripheral liquid change
Renal effects
Immersion
Decrease of transmural pressure
Increase of capillary re-absorption
Increase of plasma volume
Central hypervolaemia
Increase of ANF
Decrease of ADH and RAAS
change of renal dynamic
Increase of diuresis
natriuresis etc.
Indications
of thermoneutral baths
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Muscle relaxation and join relief
– rheumatic diseases
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Relaxant effect by sympaticolysis, suppression of
stress hormones and muscle relaxation
– Psycho-vegetative syndrome
– Psycho-physical overloading
– Convalescence
Indications
of thermoneutral bath

Dehydration effect by improved capillary reabsorption 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
water

Cold:
 Thermoneutral:
 Warm:
 Hot:
lesser than 32 °C
34-35 °C
till 38 °C
more than 38 °C
Effect of cold bathing

Thermal stimuli for training of blood flow
regulation
– Functional disturbance of blood flow
– Phlebopathy
– Cardio vascular diseases
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Thermal stimuli for training of inurity
– Infect prophylaxis
Effect of cold bath on epinephrine
by Bühring
Body temperature
o C 37
36,5
o C 35
15
ng/l 600
Water temperature
Erwärmung bis 1 oC unter Rektaltemperatur
15 o C
Epinephrine
Nephrine
400
200
0
Before 0 10 20 30 40 50 60 70
min.
Hormonal 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 acetylcholinehyperaemia period is longer. To get this reaction the
cold stimulation should be not very strong.
Rules 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 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 bathing
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Thermal stimuli for training of vegetativehormonal functions
–
–
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Convalescence
Psycho-vegetative syndrome
Cardio vascular regulation disturbance
Metabolic disorders
Effect of hot bathing
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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 circulation
by Barcroft
%
Blood circulation in muscles
100
80
60
40
oC
Water temperature
45
40
35
30
25
0
10
20
30
40
50
60
70
80
90 100 110 120 min.
Heart rate in hot baths
Temperature
of water
Heart rate
Respiratory
minute volume
Heat-transfer
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Moving water: Convection
– Quickly heat transfer
(stronger temperature sensitivity)
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Not moved water or mud: Conduction
– Slowly heat transfer (lower temperature
sensitivity)
Heart rate by coldness shock
Diving after Sauna in cold water
Blood pressure
Increase of
heart rate
Sauna
Control
Inure effect by stimulation of stress-proteins
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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-proteins
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Stress-proteins are produced by
– Normal cell grow
– Cell division
– Grow factors
– Cell differentiation
Inure effect by stimulation of stress-proteins
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Stress-proteins are produced by
– Diseases
– Virus infections
– Fever
– Inflammations
– Circulation disturbances
– Hypertrophy
– Oxidation
– Cancer
Inure effect by stimulation of stress-proteins
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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 bathing

During immersion:
increased cardiac preload results in a decompensation risk
Be careful by
Cardiac rhythm disturbance and
Angina pectoris
 After immersion:
collapse trend
Be careful by
Venous disease and
orthostatic irregularity
 During bathing:
burdening of the respiratory and lung function
Be careful by
respiratory insufficiency
Contra indications in bathing

Strong febrile and infective diseases
 Heart-insufficiency stage III and IV (NYHA)
 Hypertension stage III (WHO)
 Acute skin diseases and large skin lesions
Hydrotherapeutic measures
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Washings
 Affusions
 Baths
 Water stepping
 Brushings
 Packs and wraps
Holding the tube to prove the
water pressure for affusions
Knee-affusion
Arm-affusion
Over-affusion
Flash-affusion
Upper part washing
Lower part washing
Putting a wrap
Breast-wrap
Arm-wrap
Wet-socks
Lumbar wrap
Hay-sack
Loam-pack
Half-bath
Seat-bath
Foot-bath
Arm-bath
Steam-bath
Water stepping
Hydrotherapy in cardiac-circulation
problems
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Functional tachycardia:
– Cold compress, cold hand- or arm bath till 1 min., hand
joints 2 minutes under coldwater valve
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Bradycardia:
– Warm arm bath rising from 36 to 39 °C
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Cramp in the leg:
– Soft warm (37 °C) and cool (20-22 °C) changing washings
or affusions
Hydrotherapy in respiratory
problems
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Strong cough:
– Arm- or foot-bath rising from 35 to 40 °C
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High fever (Pneumonia):
– Cool breast-washings or -wraps
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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 neuralgia
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Acute sciatica:
– cold compress to the lumbar region
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Chronic sciatica :
– warm-hot compress
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Shoulder-arm-neck-pain:
– hot compress, soft massage, neck roll
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Sleep disturbance:
– In bed cool washings and calf-wrap
Hydrotherapy in disturbances
of the abdomen
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Colic without fever:
– Hot packs
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Kidney-bladder-colic:
– Rising hot foot-bath or seat-bath
Conclusion in hydrotherapy
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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