THE PHYSICAL AND PSYCHOLOGICAL BENEFITS OF

HYDROTHERAPY
By
CHRISTINA M. PULLIAM
A SENIOR THESIS
in
GENERAL STUDIES
Submitted to the General Studies Council
In the College of Arts and Sciences
At Texas Tech University in
Partial fulfillment of
The Requirements for
The degree of
BACHELOR OF GENERAL STUDIES
APPROVED

DR. pANA DREWLINGER

Department of ~ealth, Physicat Education
and Recreation
Co-Chair of Thesis Committee

DiE'

ROSEMARY COGAN
Department of Psychology
Co-Chair of Thesis Committee
Accept~

DR. DALE DAVIS

Director of General Studies
May 1999

fl,(!,

gog,S'
13

ACKNOWLEDGMENTS

/C;91

/tJD /~
~. Z---

I would like to thank those who assisted me in

developing my thesis; they are, in particular, my Thesis

Committee members: Dr. Dana Drewlinger and Dr. Rosemary
Cogan.

Special thanks also needs to go to my mother, who

was my driving force and my helpful editor.

Lastly, I

would like to thank Dr. Dale Davis and Ms. Linda Gregston
for advice on my topic and just general counsel.

II

TABLE OF CONTENTS
ACKNOWLEDGEMENTS

ii

CHAPTER
I.
II.

III.

IV.

INTRODUCTION: EXERCISE

HYDROTHERAPY
Background

9
9

Water Properties
Gravity and Buoyancy
Hydrostatic Pressure
Turbulence
Temperature
Summary

12
12
14
14
15
15

Physiological Effects

16

Psychological Factors
Anxiety
Depression
Sununary

17
17
18
20

HYDROTHERAPY AND PAIN

21

PAIN AND HYDROTHERAPY

22

PSYCHOLOGICAL FACTORS

24

CONCLUSION

26

BIBLIOGRAPHY

28

III

""""'-

CHAPTER I
INTRODUCTION: EXERCISE

Hydrotherapy is the union between water and physical

therapy.

It is being used widely throughout the country as

a form of exercise and physical therapy. By working in a

hydrotherapy department of a physical therapy clinic, one
may see how people and patients use hydrotherapy in their
daily lives.

Patients are instructed through a specific

program designed to help their physical conditions, while

people who are there to exercise use the water to aid them
in their workout.

Whether the person is a patient or

someone who exercises, hydrotherapy is a great way to

exercise the body.

Before presenting an explanation of

what hydrotherapy is, an explanation of how exercise

benefits the body will be given.

Hydrotherapy is exercise,

and as with any exercise, it affects one's body and mind.

Exercise has been shown to benefit a person
physiologically by reducing the risk of diseases and
improving a person's quality of life (Bellows, 1994).
Exercise is defined as "activity for developing the body or
mind"

(Webster's New World Dictionary, 1990, p.208).

Physical activity can help the body by decreasing the risk

1

...,of coronary heart disease (CHD), hypertension, diabetes,

osteoporosis, and obesity. To help reduce the risk of CHD,
fat and fat-consuming compounds need to be metabolized.

To

metabolize fats and fat-consuming compounds, a person needs

to engage in vigorous exercise (Bellows, 1994).

Obesity

has increased over the years in the United States (Burnham,

1998).

Obesity is defined as excess body fat and obesity

results in adverse health effects.

It has been shown that

a people can reduce the risk of CHD by losing approximately

5 to 10% of their bodyweight (Burnham, 1998).

Losing

weight and exercising are not the only things that can help
to reduce the risk of CHD.

Eating foods that are good for

your body and maintaining a healthy lifestyle are other

components of reducing the risk of CHD, but exercise plays
a major role.

(Physical Activity, 1992)

Physical activity can help reduce CHD, which is on the

rlse ln our country (Physical Activity, 1992; Burnham,
1998).

Just as people try to keep their bodies healthy to

prevent cancer, they should do the same for CHD.

Of the

2.1 million deaths that occurred in the United States

during 1987, 27.5% were due to CHD (Physical Activity,
1992).

Anyone is susceptible to the risk of CHD, although

---

--

-"

one of the strongest risk factors for CHD is a sedentary

lifestyle (Burnham, 1998).
A sedentary person is twice as likely to develop CHD
as someone who is physically active (Rooney, 1993).

One

way that exercise helps to reduce the risk of CHD 1S that

it increases the oxygen supply to the body.

When one 1S

exercising, one's body requires more oxygen, which results

in heavier and faster breathing.

Oxygen helps with the

circulation of blood around the body.

The increased blood

flow and oxygen into the body helps to reduce the formation
of atheriosclerosis (clogging of the arteries), which
reduces the risk of CHD (Bellows, 1994).

As the blood

circulates around the body, waste products of metabolism

are collected from the cells and are eliminated.
A type of exercise that will increase oxygen
consumption and blood flow to the body is aerobic exercise.
Aerobic exercise is any exerC1se that 1S continuous in
nature, lasts more than 20 minutes at a level to elevate
the heart rate, and involves the use of large muscle groups
(Rooney, 1993; Sova, 1992).

Therefore, to increase oxygen

consumption and blood flow to the body, a person needs

aerobic exercise.

There are many forms of aerobic

exercise, which include running, biking, swimming, and

3

----

-- .-------------------------------------------------

certain aspects of hydrotherapy (Ruoti, Morris. & Cole,

1997; Sova, 1992).
Hydrotherapy is a beneficial aerobic exercise program
for a person to perform without the problems associated
with other land-based exercises such as running, which
causes stress on many weight-bearing joints of the body.
The problems of joint pain,

joint wear, and joint injury

occur from constant jarring and stress.

Does exercise

really help the body? There has been a strong association

between physical activity and increasing the life
expectancy by one to two years (Physical Activity, 1992).
How can physical activity increase the life expectancy
of a person?
metabolism.

Physical activity increases the body's

When a person is sedentary, his or her

metabolism is not very active or high, which can lead to

increases in weight gain and body fat.

For example,

incoming college freshmen were more than likely very active

in high school sports, but when some do not continue to
exercise, they gain weight.

Freshmen students often have a

lower level of activity; therefore, their metabolism will

be slower and they may gain weight.
increased with aerobic exercise.

Metabolism can be

Aerobic exercise also

benefits the muscles and bones in the body by making them

stronger.

All of these factors (metabolism, muscles, and

the cardiovascular system) playa major role in keeping the

body physically fit.
When people are physically fit,

they can live longer

because all causes of mortality are reduced (Burnham,

1998).

Even a minor increase in physical activity can

increase a person's lifespan and reduce the risk of

cardiovascular disease.

However, a more rigorous aerobic

exercise program would be required to achieve a state of

cardiovascular fitness.

People who start exercising at the

age of 60 years old and older, and who participate in

adequate exercise programs, have increased their life
expectancy by 1-2 years (Rooney, 1993).

As people get

older it becomes harder to deliver oxygen from the heart

and lungs to the rest of the body.

By exercising, older

people can reduce this age-related factor (Rooney, 1993).

Exercise has been found to prolong an active life
expectancy as well as the total life expectancy.

Many

people believe that being active is more important than

just living (Rooney, 1993).

In a clinical environment,

many people 50 years and older come to exercise in order to

maintain or regain an active lifestyle.

A visible

difference can be noted in those who exercise on a regular

5

basis versus those who have not exercised in some time.

People who exercise also tend to have more positive
outlooks and seem to be less stressed and have decreased
feelings of depression (Byrne & Byrne, 1993).
Exercise can also help reduce symptoms of depression
and anxiety and promote a general feeling of well-being
(Cramer, Nieman, & Lee, 1991).

After exercise, a person

may experience improvement in mental attitude.

Reports

have shown that when a person performs even the smallest

amount of exercise, such as quickly walking for ten
minutes, the amount of tension, depression, anger, or
confusion may be reduced while the feeling of well-being
lncreases (Jordan, 1991).
The feeling of well-being that a person feels after an
intensive workout may be caused by endorphins.

Defined as

"natural painkillers and important neurotransmitters,

especially for emotions, endorphins react with opiate
receptor sites in a cell (the same area in which opiate
drugs react), binding with the sites to reduce pain.

Beta-

endorphins, also natural painkillers, are often released

during exercise."

(Barnes-Svarney, 1995, p.312)

Endorphin

secretion has been implicated in increased pain tolerance

and reduction in anxiety (McArdale, Katch, & Katch, 1996).

~----------------------------------------~---

Results from another study indicated that exercise was an

effective antidepressant (Goldberg & Elliot, 1994).

The

longer the exercise program that one participates in,

whether it is aerobic or anaerobic,
is in decreasing depression.

the more effective it

One philosophy is that

exercise 1S more effective for decreasing depression than

relaxing or participating in an enjoyable activity such as
reading a book or gardening (Anthony, 1991).

Also,

exercise helps decrease depression just the same as

psychotherapy.

The most effective antidepressant is the

combination of psychotherapy and exercise (Anthony, 1991).

One of the risks that accompanies exercise is that
people can develop a dependency on physical activity. In
Mondin, Morgan,

Piering, et al (1996), observations were

done on the effects of habitual exercisers deprived of

exercise.

The results indicated that those who are

habitual exercisers and are deprived of exerC1se for 48

hours may develop mood disturbances such as increased
anxiety and increased levels of depression and tension.
additional result suggested that after 72 hours,

the

deprived exercisers showed a partial recovery 1n mood

disturbances.

This evidence helps to support the notion

that exercise can help decrease depression and anxiety.

An

The purpose of this paper is to illustrate the

physiological and psychological benefits of a specific kind
of exercise and physical therapy - hydrotherapy.

For the

past eight months I have been working at Rehability Center

in the Aqua Therapy Department.

During this time period, I

have assisted patients and regular exercisers in the pool.

Direct patient care has led me to believe that hydrotherapy
has helped various kinds of conditions such as a patient
"rehabbing" from arthroscopic surgery to someone who needs
simple physical activity.

Hydrotherapy can be a positive

way to exercise and rehabilitate a person's body.

In Chapter II, historical information about
hydrotherapy will be presented.

Also, a discussion about

how hydrotherapy helps the body and mind will be debated.

Next, Chapter III will discuss how hydrotherapy can help
relieve pain.

Finally, a conclusion with a summary of the

benefits of hydrotherapy will be given.

CHAPTER II
HYDROTHERAPY

Background

The word "hydrotherapy" derives from the Greek hydor,

meaning water, and from therapeia, meaning to heal,
respectively.
forms,

Hydrotherapy can be administered in many

including pools, tanks, baths, and packs.

Hydrotherapy is also known as aquatic exercise therapy,

Aquatic exercise therapy is the union of aquatic
exercise and physical therapy.
It is a comprehensive
therapeutic approach that uses aquatic exercises
designed to aid in the rehabilitation of various
conditions.
It is an innovative approach to
aquatic therapy that promotes independence among
patients, requires less staff time, and maximizes pool
usage, compared with traditional pool programs. (Bates
& Hanson, 1996, p.l)
Additionally, hydrotherapy has been defined as a pool
therapy program designed, conducted and supervised by
qualified personnel.

Its purpose is to help improve the

neuromuscular skeletal function of the body (Goldby &

Scott, 1993).

To treat many diseases, including muscle

spasms and joint diseases, Hippocrates (460-375 BC) used

hot and cold-water immersion (Ruoti, Morris, & Cole 1997).
Initially, bathing centers, which included hot and coldwater immersion, were developed by the Greeks.
9

However,

the Romans, by 330 AD, developed the baths for treating

injuries and healing diseases, using various water
temperatures.

The Roman bath system declined with the

Roman Empire by 500 A.D. due to deterioration of the bath

structure and the lack of upkeep (Ruoti, Morris, & Cole,
1997).

Even though this did not deter some people from

using hot and cold water, it was not something that

everyone believed in anymore.
During the 1700's and early 1800's, baths were not
accepted, even for hygenic purposes.

However, wet, cold

and hot packs continued to be used for muscle soreness and

other medical problems.

During this same time period in

the United States, people thought of water not only as a

healing agent but also for hygienic purposes.

Bathing

techniques were taught to the early settlers by Native

Americans, who were using water for magical, religious, and
hygenic purposes.

Many early settlers took this

information and, ln 1830, the first bathhouse in the United

States was built ln Hot Springs, Arkansas.

(Ruoti, Morris,

& Cole, 1997)

During the 1930s many physicians in Europe brought the
current teachings of hydrotherapy to America.

These

teachings were introduced in the medical schools, and

10

American physicians began to set up spas of their that

incorporated the use of hydrotherapy (Ruoti, Morris, &
Cole, 1997).

Although Europeans used their spas more than

Americans did, the use of spas, in conjunction with

hydrotherapy, was on the rise, especially after the Civil
War.

The use of advertising caused an increase in the use

of spas and hydrotherapy.

By the twentieth century, however, the use of spas
started to decline.

Physicians and patients lost interest

in the use of spas for treatment of medical problems.

Hydrotherapy was still being used, but it was not as
popular as before (Ruoti, Morris, & Cole, 1997).

By the

early 1990's, hydrotherapy again began to be used more

frequently.

Today, aquatic physical therapy is included,

if needed, in a patient's treatment plan, and in 1992 two

physical therapists founded a section of the American
Physical Therapy Association known as Aquatic Physical
Therapy (Ruoti, Morris, and Cole, 1997).
Now that the historical background of hydrotherapy has
been given, an explanation of how hydrotherapy helps the
body will be discussed.

11

.----

._----------------------------------------------------

Water Properties
Hydrotherapy involves the use of water.

There are

five physical properties of water that have a direct

bearing on pain relief.

These include gravity, buoyancy,

hydrostatic pressure, turbulence, and temperature (Skinner,

& Thomson, 1994).

Gravity and Buoyancy

When an object is placed in water, it has two opposing
forces acting on it: gravity and buoyancy.

Gravity is a

natural force that pulls objects toward the center of the

earth in a downward motion. According to Archimedes'
Principle, when an object is immersed ln a fluid, either
completely or partially, there is an upward force that is
equal to the weight of the fluid displaced.
called buoyancy.

This force is

Buoyancy is the force opposing gravity in

water (Hall, 1999; Sova, 1992).

These two forces are the

major factors that contribute to why hydrotherapy is a

great way to exercise and to rehabilitate an injury.

person may feel lighter in the water due to the forces

opposing each other, which provides pain relief for many
symptoms and helps people to move easily (Hall, 1999;
Skinner & Thomson, 1994).

Due to these counteracting

forces, patients may be able to obtain a better range of

12

motion more easily and quickly which may aid with any type
of post-surgery condition.

Patients who participated in a

study that measured the use of spa therapy to improve the

quality of life of chronic low back pain patients found
that their pa1n was reduced and their movements became
easier and stronger (Constant, Guillemin, Collin, &
Boulange, 1998).

The effect of the buoyancy force helps to

make exercising in water comfortable for patients who have

lost body tissue after a debilitating disease or muscle
atrophy after surgery because there is no localized
pressure on the patient's bony prominences (Skinner, &
Thomson, 1994).

Arms,

legs, and the trunk of the body can

be moved more easily underneath the water surface also due

to gravity and buoyancy.

Underneath the water,

the freedom

of movement and freedom from pain helps to bring synovial

(joint)

fluid to the joint and sweeps the fluid across the

joint, thus giving it lubrication and nutrients, which

helps the person to regain a full range of movement in
joints (Skinner, & Thomson, 1994).

Another force acting

against the body to help relieve pain in the body 1S

hydrostatic pressure.

13

Hydrostatic Pressure
Hydrostatic pressure allows tension to be evenly
distributed over all surfaces of the body.

The pressure 1S

greater in deeper water and less near the surface due to

the fact that hydrostatic pressure is directly proportional
to the depth and density of the water (Bates & Hanson,
1996).

This pressure aids in venous blood supply, which

takes waste products out of muscles and tissues and, in

return, provides pain relief (Skinner & Thomson, 1994).
The pressure does not allow blood to gather in the lower
half of the body, which reduces unnecessary swelling and
pain.

As a person moves throughout the water, the water 1S

also moving.

This is called turbulence.

Turbulence
Turbulence 1S an irregular movement of water
molecules.

It can be created by a person mov1ng ln the

water or by an underwater jet from a hosepipe connected to

a whirlpool.

The jet propels water around a painful area

or on the tissues directly.

A person in the water with a

patient can cause turbulence by acting in the same way that

the jet does in the whirlpool by walking in front of them,
thus causing the water to move in irregular movements.
14

The

pressure from the turbulence helps to stretch tight tissues

and allows the movement of fluid through joints.

Patients

report dramatic pain relief from this modality (Skinner &

Thomson, 1994).

Temperature
Temperature plays a key role in hydrotherapy.

The

water temperature in a hydrotherapy pool is maintained

Q

around 3S C and 36C.

The entire time the patient is being

treated in the water, the body is being warmed.

When the

body is warmed, relaxation is induced, and muscle spasms

are reduced (Bates & Hanson, 1996).

In turn, this helps to

increase the circulation flow around the body and

facilitates the movement of joints.

Temperature in

conjunction with gravity, buoyancy, hydrostatic pressure,

and turbulence helps to relieve the body of certain
symptoms.

Summary
These five factors (gravity, buoyancy, hydrostatic
pressure, turbulence, and temperature) are the main reasons
why water is part of a patient's physical therapy plan.
Patients are able to make movements easier ln the warm
water than on land and can perform activities through a

15

greater range of movement.

Patients find great pleasure

from the freedom of movement that water offers and that

land does not (Skinner, & Thomson, 1994).

The water

properties help people feel weightless, and this advantage

can be used to help medical problems that are hampered by
weight.

It creates an environment of decreased impact and

decreases weightbearing stress on bones and tissues (Ruoti,

Morris, & Cole, 1997).

Physiological Effects
As the body is immersed in water, there is significant
compression on all body tissues (Ruoti, Morris, & Cole,
1997).

When a patient is immersed and exercises in the

water, there is an increase in blood supply to the muscles,

which ln turn increases muscle metabolism (Duffield, 1976).
Also, a patient's respiration rate will increase, causing a
decrease in blood pressure.

When the body is immersed ln

water, there is resistance placed on the diaphragm due to

hydrostatic pressure, which allows the lungs to take ln
more oxygen (Sova, 1992).

In return, more oxygen is

delivered to the tissues and muscles, thereby increasing

the circulation of blood around the body and decreasing the
risk of CHD (Duffield, 1976).

Hydrotherapy not only helps

16

the body physiologically but also in turn helps the mind

psychologically.

Psychological Factors
After taking a shower or bath, many healthy people
feel invigorated and relieved from daily anxieties.

The

immersion in water can have greater psychological effects

than physiological effects.
benefit the mind.

As stated before, exercise can

Since hydrotherapy is a form of

exercise, it also helps to benefit the mind (Hecox,

Mehreteab, & Weisburg, 1994).

Just as any other exercise,

hydrotherapy helps to reduce tension, anxiety, and

depression and thus helps to promote well being.

Anxiety
Anxiety is defined as "an emotional state
characterized by physiological arousal, unpleasant feelings
of tension, and a sense of apprehension, foreboding and
dread about the future"
p.S8S).

(Nevid, Rathus, & Greene, 1997,

The warm water and water pressures (buoyancy,

gravity, and hydrostatic pressure) of the pool help the

patient to relax the muscles in his or her body (Duffield,
1976).

Once a person relaxes, he or she can release and

reduce tension throughout the body.

17

The water pressure

helps to make the body feel weightless. The whole body may
feel as if 100 lbs. has been lifted, making it very easy to
release tension that is built up.

Hydrotherapy helps

people feel a sense of personal control when they can

exercise and move their bodies in the way they want to
(Goldberg & Elliot, 1994).

The water and other stimuli

(such as other patients) help to distract a person from

thoughts about stressful and anxiety-producing stimuli,
thereby reducing anxiety (Goldberg & Elliot, 1994).

During

planned hydrotherapy sessions, patients may talk with each

other while performing their exercises, which will distract
them from their stresses in daily living.

If a person

continues to reduce anxiety by hydrotherapy or exercise, he

or she can improve psychological responses (Goldberg &
Elliot, 1994).

Hydrotherapy not only helps to decrease

anxiety, but can also help in reducing depression (Cramer,

Nieman, & Lee, 1991).

Depression
Depression affects almost everyone at some point in
his or her lifetime.

When a person is sad, discouraged,

and has feelings of hopelessness, this person is described

as depressed (Goldberg & Elliot, 1994).

Depression may be

reduced in the same manner as anxiety is by using warm

18

water and water pressures.

First, hydrotherapy enhances

self-confidence and improves self-efficacy, thereby

reducing symptoms of depression.

As with anxiety,

exercising in water helps the person understand that there

is still hope in doing things that he or she wishes to
(Goldberg & Elliot, 1994).

Hydrotherapy may help depressed

individuals and victims of serious accidents or injuries

gain self-confidence and hope.

Once they gain confidence,

they may start to gain hope and positive feelings, which in

turn reduces depression.
Secondly, hydrotherapy and exerClse allow distractions
to occur, shifting attention from negative feelings to
allow more positive feelings and thoughts to emerge.
exercise facilities establish a social setting.
setting provides a social support for people.

Most

This
Since the

use of hydrotherapy is on the rise, this is a great way to

promote social interaction and to gain the social support
patients need (Goldberg & Elliot, 1994).

Knowing that

there is someone to talk to while exercising can bring out

positive feelings and help a person to continue with
hydrotherapy or exerClse.

Thus hydrotherapy can help

reduce anxiety, depression, and physiological problems.

19

Summary
In summary, a person's well-being includes mental as
well as physical health and fitness (Goldberg & Elliot,
1994).

A person's well-being depends on exercise.

Hydrotherapy is a great way to exercise to relieve some

psychological problems one may have.
There is one physical and psychological problem that
has not been discussed and that is pain.
ease pain?

20

Can hydrotherapy

CHAPTER III
HYDROTHERAPY AND PAIN

Pain is defined as "physical or mental suffering caused by

injury, disease, anxiety, etc." (Webster's New World
Dictionary, 1990, p.422).

Exercise is now being used as a

therapeutic way to treat physical and psychological

problems.

When people are not active and increase ln age,

they can lose muscle strength, flexibility, and

cardiovascular conditioning and can have severe mood
changes (Lomaranz & Motofsky, 1997).

These factors can

cause a reduction ln motor function and can increase

experiences of paln.

The majority of this loss has been

attributed to a lack of exerClse.

Reports indicated that a

high overall fitness level helped to protect the body

against physical and psychological problems (Physical
Activity, 1992).
Many patients who seek physical therapy do so because
they have injured themselves doing activities around the
house or in the garden.

When people are inactive,

especially older people, they cause injury to themselves by

thinking that they can still do things that they did when
21

they were younger (Lomranz & Mostofsky, 1997).

The

majority of these patients do not participate in an

exercise program.

When a person is inactive, the muscles

and bones become weak and stiff.

Therefore, when a

physical demand is placed on the body, the body attempts to

react in a manner of prior conditioning.

Since the body

1S

not used to this physical demand, the movement may feel

slow, painful and stiff or total muscle failure can occur
(Philips & Rachman, 1996).
a lack of activity.

Flexibility is also affected by

A decrease in flexibility may limit

daily activities such as cleaning the house or placing

things on a high shelf (Adrian & Cooper, 1995).

Exercise

can be one of the most potent ways for preventing and

treating such pain (Lomranz & Mostofsky, 1997).

Pain and Hydrotherapy

Pain is the number one complaint after surgery
(Meeker, 1998).

Discomfort can cause increased anxiety and

stress, which can interfere with normal levels of pain

experienced by a person.

Hydrotherapy is started soon

after surgery, which relieves pain by relaxing muscles

(Meeker, 1998).

After surgery, patients reported pain

relief and freedom of movement while immersed in the water

22

(Constant, Guillemin, Collin, & Boulange, 1998).

Patients

with low back pain that participated in a hydrotherapy

program reported having a reduction in daily pain and in
drug consumption to reduce the pain, and an increase in
mobility (Broach & Dattilo, 1996).

Also, patients after

knee surgery report pain relief and increased strength ln

their legs, making their rehabilitation on land eaSler
(Skinner & Thomson, 1994).

Ahern, Nicholls, Simionato, &

Clark (1995) found that hydrotherapy reduced pain and

stiffness in patients with rheumatoid arthritis and
osteoarthritis.
Hydrotherapy enhances relaxation and relieves muscle
tension, thereby reducing pain and giving the patient
relief.

The warm water helps the muscles to relax, thus

reducing a patient's pain.

When the muscles relax, this

increases sensation throughout the body and helps to

prepare the connective tissue for stretching (Bates &
Hanson, 1996).

In turn, this helps to increase range of

motion, which also helps to decrease pain.

Mentally, when

people do not exercise, they can become tense, anxious, and

moody, and experiences more psychological problems
(Anthony, 1991).

23

Psychological Factors
Exercise can affect mood.

When a person

1S

inactive,

the person may feel helpless and sad, which may lead to
depression.

An individual's tolerance of pain can be

affected by depression (Philips & Rachrnan, 1996).

Many

patients believe that they are limited in physical motion

and that they will never have their physiological functions
restored to equal the level prior to injury, causing mood
disturbances.
tolerance.

People with depression have a lower pain

Suffering is an emotional response to pain

(Lomranz & Mostofsky, 1997).

Pain has as big an impact on

the psychological well-being as it does on physiological

well-being (Philips & Rachrnan, 1996).

Emotional suffering

can affect the body just as not exercising does.

An

emotion, such as grief, may not start out as suffering, but

produces suffering very quickly (Lomranz & Mostofsky,
1997).

Once patients are in the water and realizes that

they can move their bodies, they start to gain confidence

in themselves and their self-image starts to change.
these changes, positive attitudes start to emerge,
eliminating the pain and suffering from anxiety and
depression (Lomranz & Mostofsky, 1997).
24

With

Do all exercises help to relieve pain and suffering?

Land-based exercises seem to increase paln ln people who
have a low-tolerance of pain, such as the elderly or those
who feel that they may injury themselves more on land
(Skinner & Thomson, 1994).

Hydrotherapy can be an

effective way to ease pain for those who do not want to

participate in land-based exercise programs.

25

CHAPTER IV
CONCLUSION

In conclusion, hydrotherapy benefits both the mind and

body by relieving pain.

Hydrotherapy involves the use of

water, which benefits people 1n a way that other exercises

cannot do.

Water is the key to hydrotherapy.

The physical

properties of water (gravity, buoyancy, hydrostatic

pressure, turbulence, and temperature) help persons to
exerC1se their body and mind.
The majority of the people treated at Rehability are
patients who recently have had surgery (postoperatively)
and for whom pa1n 1S the number one complaint.
Hydrotherapy is used immediately after surgery during the
patient's postoperative period.

During this period,

hydrotherapy enhances relaxation and relieves muscle

tension, giving the patient pain relief.

The buoyancy

force decreases the compression forces, allowing the joint

to move easier within the water, which 1n turn decreases
the pain.

Once the pain is decreased, the patient is able

to move the joint more freely,

movement.

increasing the range of

After range of movement is gained, muscle

26

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strength needs to be gained as well.

Water provides a

great medium for a patient to work in because it creates a

resistance.

Water has twelve times the resistance of air

(Sova, 1992).

For the patient it is easier to move in

water than on land and without the pain of active movement.

When the patient's body is submerged in water, resistance
occurs on all body parts in every direction of movement
(Bates & Hanson, 1996).
As explained above, all the properties of hydrotherapy
can help to reduce the pain of physiological origins.
Hydrotherapy is a great way to reduce pain and rehabilitate
injuries.

Many physical conditions, not just postoperative

care, can be treated with hydrotherapy.

27

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