Using the physical properties of water such as buoyancy (reducing the effective weight of the body), water resistance to movement and hydrostatic pressure, hydrotherapy provides a fully supportive environment for exercise. These characteristics reduce the pressure on the joints and make the muscles less tense. As a result, the patient's pain is relieved and movement becomes easier. For example, due to the high buoyancy, the force of gravity is removed from the knee and other joints and the patient feels light. In addition, the intensity of the exercises can be controlled by changing the depth of the water; The greater the depth, the higher buoyancy and less joint load is felt, so it is possible to exercise with less pain.

Benefits of water therapy in reducing pain and strengthening movement

• Reducing pain and muscle spasm: the gentle heat of the water and high buoyancy relax the muscles and reduce their tension. The dilation of blood vessels due to the heat of water and the increase of subcutaneous blood flow reduces the sensitivity of pain receptors. In this way, joint pain and muscle cramps are reduced to a great extent and the range of motion of the patient is improved.
• Strengthening muscles and improving balance: The natural resistance of water to movement acts like a gentle resistance exercise. By increasing the speed or angle of movement of the limbs in the water, resistance also increases and weak muscles are gradually strengthened. Also, the supporting effect of water increases balance and movement coordination and reduces the risk of falling during exercise.
• Increasing flexibility of joints: stretching movements and range of motion are easier in water; Because water prevents the bones from suddenly colliding and keeps the joints at a moderate temperature. For this reason, the ability to move in larger domains is maintained and even increases over time.
• Safe and motivating environment: Hydrotherapy is usually performed in a low-risk environment that reduces the patient's anxiety. The supportive environment of water, especially for the elderly or frail, creates a sense of self-confidence and increases motivation to participate in exercise. This factor makes participation in physiotherapy sessions better and more continuous.

Review studies have shown that doing water sports has positive clinical effects in reducing pain and improving motor performance. For example, a meta-analysis on patients with chronic musculoskeletal disorders reported that, compared to immobility, aquatic exercise programs resulted in a significant reduction in pain intensity (SMD = -0.64) and improved physical performance and quality of life in these patients. Other studies have also shown that hydrotherapy improves the quality of movement of patients by relieving pain and reducing disability.

Hydrotherapy implementation methods

Water therapy can be implemented in various ways, which are chosen depending on the needs of the patient and the prescription of the physiotherapist. Among the common methods are:

1. Exercises in the hot water pool: the patient performs aerobic, strengthening or balancing exercises in the water pool under the supervision of a physiotherapist. The water temperature is usually set between 33 and 36 degrees Celsius to relax the muscles and optimize local blood circulation. The depth of the water can vary from the torso to the neck so that the pressure on the joints can be adjusted according to the patient's needs.
2. Hot tub and jacuzzi: full or partial immersion in a hot tub (or using the water massage jets in the jacuzzi) helps to relax the muscles of the back and legs and reduces muscle pain. The flow of hot water increases the local blood supply by dilating the blood vessels and accelerates the tissue healing process.
3. Alternating hot and cold showers (contrast therapy): In this method, the patient alternates between hot and cold showers so that the blood vessels first dilate and then contract. This temperature change improves local blood circulation and reduces inflammation. Usually, a warm shower is used for immediate pain relief and a cold shower is used to control swelling and inflammation.
4. Topical compresses: Using a hot or cold compress (like a hot water bag or an ice pack) on the painful area is a simple and effective method. A warm compress relaxes the muscles and increases local blood supply, and a cold compress helps reduce pain quickly in cases of acute swelling.
5. Expert supervision: All hydrotherapy methods must be performed under the supervision of a physiotherapist or a specialist hydrotherapist so that the intensity of exercise and safety conditions are adjusted according to the patient's condition.

Physiological effects of hydrotherapy

Exercising in the water environment has certain physiological effects that are significantly different from activities on land. The most important of these effects are:

1. Water Buoyancy: The buoyant force of the water greatly reduces the effective weight of the body, so that the patient experiences a state of "weightlessness". This feature reduces the gravitational pressure on the joints (for example, knee and hip joint) and increases the power of movement.
2. Hydrostatic pressure: the pressure exerted by water on the entire surface of the body is the same and increases with increasing depth. This uniform pressure increases the return of blood and lymph from the organs to the heart and also reduces local swelling. In this way, accumulated fluids in joints and tissues are drained and cellular nutrition is improved.
3. Water viscosity: The inherent resistance of water to flow and movement slows down body movements. This works the muscles slowly and in a controlled manner and helps improve muscle coordination by strengthening sensory-motor skills (proprioception).
4. Effect of water temperature: Immersion in warm water causes dilation of surface vessels and increase of blood flow. This increase in blood flow along with the increase in muscle temperature reduces the sensitivity of nerve endings to pain and lowers muscle tone. As a result, joint pain and muscle spasms are relieved. On the contrary, contact with cold water causes temporary constriction of local blood vessels and is useful in cases of acute joint inflammation.
5. Increasing general blood circulation: exposure to water reduces peripheral blood pressure to some extent; The hydrostatic pressure of the water increases the volume of blood returning to the heart and causes a slight increase in the heart's work. Also, maintaining a higher body temperature in water increases muscle metabolism and requires more oxygen.

Scientific evidence about hydrotherapy

Several studies have confirmed the positive effects of hydrotherapy. Systematic reviews and meta-analyses show that hydrotherapy can reduce pain and improve motor function:

• A meta-analysis including 32 studies on patients with chronic musculoskeletal diseases reported that the aquatic exercise group showed a significant reduction in pain (SMD = -0.64) and improved physical performance and quality of life compared to the control group.
• In patients with chronic back pain, another systematic review showed that water exercises significantly reduce the intensity of pain and disability and improve the quality of life.
• Limited studies in specific diseases such as knee arthritis have also stated that hydrokinesitherapy (water exercise) effectively reduces joint pain and increases range of motion compared to conventional treatments.
• Similar evidence has been obtained in other diseases such as fibromyalgia. A systematic review has reported that the use of hydrotherapy in fibromyalgia patients significantly reduces pain and clinical symptoms and improves quality of life.
• Based on this evidence, scientific associations recommend patients with knee and hip arthritis to participate in water exercise programs. For example, the American Rheumatology Association (ACR) has strongly recommended that knee and hip osteoarthritis patients participate in aquatic exercise programs, as clinical studies have shown a significant benefit in reducing pain and improving performance.

Despite these promising results, many reviews have emphasized that long-term and higher-quality clinical studies are needed to confirm the long-term effects of hydrotherapy. In general, the available evidence shows that hydrotherapy in the right conditions can be considered a low-risk and effective method for relieving chronic pain and improving the movement of patients with musculoskeletal problems.

Frequently asked questions about hydrotherapy

1. What exactly is hydrotherapy and how is it different from regular physical therapy?

Aquatherapy is a type of physiotherapy that is performed in a water environment (usually a heated pool). Less pressure on the joints and the effects of water buoyancy make therapeutic movements easier and more effective.

2. For what diseases or problems is hydrotherapy suitable?

Hydrotherapy is useful for arthritis, back pain, stroke, Parkinson's, sports injuries, rehabilitation after surgery and many musculoskeletal problems.

3. Can all people use hydrotherapy?

In most cases yes, but people with active skin problems, open wounds, infections, or uncontrolled heart disease should consult a doctor.

4. How many hydrotherapy sessions are needed to get results?

The number of sessions varies depending on the type of injury and the patient's condition, but often 8 to 12 initial sessions are recommended to see improvement.

5. Does hydrotherapy require special skills or equipment?

Exercises should be done under the supervision of a physiotherapist trained in hydrotherapy. Some light tools such as noodles, swimming boards or water weights may be used.

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