SEMIFINALS
assistive or resistive force. There are unique principles of water that
“Hydrotherapy treatment” is treating a disease or symptoms with
the use of water. This practice dates as far back as 4500 BC. In
ancient Roman culture, bathhouses were a vital component of life.
These bathhouses spread through Europe in the 17th and
18th centuries, and finally made it to the United States in the mid
1700s. Today, the most popular American bathhouses can be found
in Arkansas and Colorado, but hydrotherapy treatment has far
evolved past baths or spas.
Types of Hydrotherapy Treatment
Hydrotherapy can be provided in various forms:
Whirlpool or Aquatic Therapy: This is a type of hydrotherapy
that a physical therapist or aquatic therapist will provide. A
therapist may use different positions or directions depending on the
results he/she wants to achieve.
Contrast Bath: As the name suggests, this is using cold and hot
water baths alternatively. Contrast baths are proven to reduce pain,
swelling, and inflammation.
Hydro-massage: Hydro-massage often uses high pressure jets.
This helps in pain reduction as well as relaxation.
Spas: Spas can involve baths, pools, showers, or whirlpools. They
are usually unsupervised and can be used for recreational purpose.
Kneipp System: The Kneipp System – named after it’s designer,
Father Sebastain Kneipp, uses different water temperatures with
herbal and mineral baths. This has various health benefits in
addition to a purifying diet or spiritual practice.
Principles of Hydrotherapy
Hydrotherapy is unique as it can act as a treatment choice for either
can make this possible:
Buoyancy: As per Archimede’s Principle of Buoyancy, a body
immersed in a liquid experiences an upward force equal to the
weight of the displaced liquid. This is why the body feels less weight
in water than on land (this is also the principle behind hydrostatic
weighing). The buoyancy of the water can assist or resist with the
exercises of the extremities. In addition, changing the speed will
either grade or change the exercise difficulty. In addition, the
buoyancy of water is affected by postural alignment and the surface
area immersed in the water.
Hydrostatic Pressure: A perpendicular pressure against the
surface of the body exerted by water is called hydrostatic pressure.
This pressure increases as the depth and density of the liquid
increases. This is why a motion is performed more easily near the
surface of the water than at greater depths.
Cohesion: Water molecules have a tendency to attract to each
other. As a result, molecules are cohesive. This causes an increase
in resistance to range of motion compared to that of the air.
Viscosity: Viscosity is an internal friction that directly depends on
the speed of the liquid. In other words, the higher the speed, the
higher the viscosity, and thus, the higher the resistance to the
movement. Furthermore, the shape of the object (the body) also
affects viscosity. A larger or more spread out object faces greater
resistance to motion in the water.
Hydrotherapy Treatment Benefits
Hydrotherapy is useful in the treatment of:
 Management of acute or chronic pain
 Rehabilitation for pre- and post-joint replacement surgery
 Relieve arthritis pain
  Improve muscle flexibility  To activate fibroblasts and to increase DNA synthesis  To treat: o
 Improve range of motion Chronic psoriasis o Acne vulgaris o Acute and chronic wounds o
 Improve strength via resistance training Uremic pruritus o Jaundice
 Weight loss
 Reduce muscle spasm Contraindications
 Fight fatigue  Contraindicated if used in combination with UVA or UVB rays to
 Aid in relaxation and lower stress levels
large body surface areas3-4 : o Congestive Heart Failure o Diabetes
o Tuberculosis o Hyperthyroidism o Systemic lupus erythematous o
Additionally, hydrotherapy is a good alternative to vigorous exercise Cardiac, renal, and hepatic disease o Herpes simplex o Syphilis o
during pregnancy, and can help with labor pains during childbirth
Cancer o Acute febrile illness
(water birth).
 Malignant wounds or history of melanoma or carcinoma
Hydrotherapy Contraindications
 In those with light allergies or light sensitive diseases, i.e.
Hydrotherapy should be avoided in the following conditions: porphyria or lupus erythematous

 Over fresh skin grafts

 Open wounds
 Active infection  Direct viewing of the lamp output (goggles required)
 Altered sensation
 Hydrophobia  AIDS/HIV
 Heat or cold intolerance
 Over areas of acute eczema or psoriasis
 Poor balance
 Deep cellulitis and osteomyelitis er the thyroid gland
Ultraviolet Therapy
 Pregnancy
Indications
 In infants
 Those who have been deemed a candidate for adjunctive
therapies, see “Determining Candidacy for Adjunctive Therapies”  Prolonged exposure times

 To reduce bacterial burden1-2  Over metal implants

 To produce a mild inflammatory response to help accelerate  Over areas of local erythema
wound healing
Precautions
 To increase vascular permeability, keratinocyte activation, wound
 Ingestion of strawberries, eggs, shellfish before treatment
epithelialization, and induction and modification of growth factors
and their receptors
 Use of birth control pills, tetracycline, quinine, diuretics, and/or caused by needle insertion when tissue is traumatized.
insulin

 Over areas of poor skin sensation

 Avoid active epiphyseal regions in children

 Avoid specialized tissues, i.e. teste

s  People with little skin pigmentation, i.e. people with blonde or

red hair

Iontophoresis (IOPP) 

IOPP is the use of a direct current to drive medications such as anti- INDICATIONS FOR USE:
inflammatory steroids and local anesthetics through the skin into
underlying tissues. It is indicated for the administration of water  Calcific tendonitis
soluble corticosteroid as an alternative to hypodermic injection. It is  myositis ossificans
used in situations when it is advisable to avoid the pain that may
 skeletal muscle spasms
accompany needle insertion and drug injection; when it is advisable
to minimize the infiltration of carrier fluids; to avoid the damage  inflammation
 adhesive capsulitis
 bursitis
 tendosynovitis
 myositis
 local edema
 muscle and joint pain
CONTRAINDICATIONS:
IOPP is contraindicated for use on electrically sensitive patients,
patients with pacemakers, patients with known drug allergies to the
drug being administered. It is also contraindicated for the use over
damaged or denuded skin or recent scar tissue, across the temporal a 4-week follow-up (p<0,001) compared to post-treatment in elbow
tendinopathy, Achilles tendinopathy, plantar fasciitis and rotator
region and for treatment in the orbital regions. cuff tendinopathy.

PRECAUTIONS:
Pain results of various tendinopathies in both shockwave
 Never attempt to reuse disposable assemblies and control groups pre-treatment, post-treatment and at
the 4-week follow-up. *Comparison between shockwave and
 Advise patients of skin irritations or burns that may occur
control groups pre-treatment, post-treatment and at the 4-
 Do not use electrodes that appear damaged or altered week follow-up. **Comparison between pre-treatment and
post-treatment within each group. ***Comparison between
 Do no apply electrodes over damaged skin post-treatment and 4-week follow-up within each group.
 Do not use on patients with pacemakers
 Do not apply the electrodes over the temporal or orbital TENDINOPATH Shockwav Control Independen P-
regions Y / PAIN e group group t t-test value*
 Patients with known skin allergies should use lower current (n=117) (n=18) differences
settings
 If blistering occurs discontinue use

ELBOW
Shockwave
Pre-Treatment 1,99±0,5 2,01±0,15 -0,02 0,721
People suffering from tendinopathies exhibit reduced mobility due
to the pain caused by the movement of the tendons involved. Mean±SD
Recently, shockwave therapy has been used as a treatment option,
which is non-invasive, simpler, faster and safer.

Aims: Post-Treatment 0,10±0,21 1,84±0,16

To record the intensity of the pain, the functionality of the upper Mean±SD <0,001 <0,001 -1,75 <0,001
and lower limbs and quality of life before treatment with shock
waves, immediately after the treatment and the 4-week follow-up. P-value**

The pain reduction and the improvement of functionality and quality

of life after shockwave treatment increased by at least two points
on the five-point Likert scale both post-treatment (p<0,001) and at
TENDINOPATH Shockwav Control Independen P- TENDINOPATH Shockwav Control Independen P-
Y / PAIN e group group t t-test value* Y / PAIN e group group t t-test value*
(n=117) (n=18) differences (n=117) (n=18) differences

4-Week Follow- 0,01±0,09 1,98±0,10 up Mean±SD 0,010 0,011 -2,45 <0,001

up Mean±SD <0,001 <0,001 -1,97 <0,001 P-value***
P-value***

ACHILLE’S
ROTATOR’S TENDON 2,35±0,54 2,15±0,14 0,19 0,202
CUFF 2,80 ±0,47 2,53±0,2 0,27 0,053 Pre-Treatment
Pre-Treatment Mean±SD
Mean±SD

Post-Treatment 0,11±0,14 1,95±0,13

Post-Treatment 0,18±0,4 2,36 Mean±SD <0,001 <0,001 -1,84 <0,001
Mean±SD <0,001 ±0,21 -2,18 <0,001 P-value**
P-value** <0,001

4-Week Follow- 0,00±0,02 1,84±0,11

4-Week Follow- 0,01±0,05 2,46±0,21 up Mean±SD <0,001 <0,001 -1,84 <0,001
 Radiofrequency
TENDINOPATH Shockwav Control Independen P-
Y / PAIN e group group t t-test value*
Radiofrequency Therapy distributes high-frequency electromagnetic
(n=117) (n=18) differences
energy into the desired tissue which leads to selective tissue
hyperthermia. Thanks to this mechanism patients experience
instant pain relief, muscle relaxation, edema reduction, tissue
regeneration support and healing. The most common indications
include: local muscle spasm, trigger points, myalgia, tendinitis,
P-value***
cervical pain, and post-traumatic edema. The immediate
therapeutic effect is noticed by the patient instantly and lasts long
after the therapy. For elderly people to continue to function
independently and perform daily activities, it is essential they
maintain sufficient muscle strength and cardiorespiratory fitness.
PLANTAR
The effect of myorelaxation is primarily based on vasodilatation,
FASCIITIS 2,52±0,42 2,52±0,19 -0,003 0,978 which occurs immediately during the therapy and is responsible for
higher supply of nutrients into the tissue. The goal of the present
Pre-Treatment study is to highlight the medical effect in recovery by using the
Targeted Radiofrequency Therapy. The main method used to fulfill
Mean±SD
this study has been even the implementation of the mechanism of
action of Targeted Radiofrequency Therapy. The findings are
regarding to the muscle relaxation, tissue regeneration and healing,
pain relief. So, the Targeted Radiofrequency Therapy helps relieve
trigger points and muscle spasms that prevent regaining the full
Post-Treatment 0,06±0,1 2,29±0,2
range of joint movement. For example use of the Targeted
Mean±SD <0,001 <0,001 -2,23 <0,001 Radiofrequency Therapy in combination with passive stretching of
the shortened structures leads to their relief and immediately
P-value** broadens the range of motion in the given segment. Combining the
Targeted Radiofrequency Therapy and isometric or isotonic muscle
contraction focuses the hyperthermia into the contracted muscle.
Delivered radiofrequency energy facilitates these fibers and leads
to their incorporation in the performed muscle stereotypes.
4-Week Follow- 0,00±0,00 2,27±0,19
up Mean±SD <0,001 0,165 -2,27 <0,001
EMG Biofeedback
P-value***
The use of biofeedback is becoming increasingly valuable in the
field of physical therapy. It has been proven effective in muscular
reeducation and muscular relaxation. Audiovisual muscular
reeducation techniques make use of electromyographic devices and
amplify internal physiological processes in the body that are
normally not seen or perceived by the therapist or the patient.
Making use of auditory and visual feedback, the patient is given two
information inputs other than those normally available to him with
which to process information concerning physiological events.
Audiovisual neuromuscular techniques are an adjunct to all the
other therapies commonly used. To use this technique, one should
be well versed in many other applied sciences like
electromyography, pathology, neurology, kinesiology, and muscle
reeducation techniques. In this chapter, we shall discuss the clinical
application of the following audiovisual neuromuscular techniques:
inhibition of spasticity, recruitment of motor unit activity, muscle
reeducation of tendon transfers, muscle relaxation, and the use of
the techniques as an evaluation tool with incomplete spinal cord
lesions. These techniques can be used alone or sometimes in
combination. I shall illustrate how they are used in different patients
with different conditions and I shall give you some case illustrations.
The types of patients we are familiar with present the following:
1. Upper motor neuron lesions, e.g., cerebrovascular accidents,
incomplete lesions of spinal cord injuries. 2. Lower motor neuron
lesions, e.g., peripheral nerve injury, Bell's palsy.
3. Hysterical paralysis.
4. Muscle spasms of unknown etiology causing pain. 5. Spasmodic
torticollis.
ELECTRODIAGNOSTIC EXAM
As with any meaningful medical consultation, the electrodiagnostic
medicine consultation must begin with obtaining a pertinent history
and performing a physical examination. The history is not discussed
in this article, but it obviously forms the basis of the ensuing
examination by providing an understanding of the referring
question, the patient's symptoms, and relevant past medical,
surgical, and social history.
The physical examination can be quite variable, depending on the
clinical history. The examination might range from a very focal
neurologic assessment, as might be the case in a focal neurologic
injury (eg, knife wound to digital nerve), to a multisystem,
generalized examination, as might be needed in a systemic disease
presentation (eg, paraneoplastic syndrome)
Purpose of an ELECTRO DIAGNOSTIC EXAM
An EDE is often used to evaluate unexplained muscle weakness,
twitching or paralysis, and to find the causes of numbness, tingling
and pain. EDE can differentiate between true weakness and
reduced use because of pain or lack of motivation. It can also
determine whether a muscle disorder begins in the muscle itself or
is caused by a nerve disorder.
In an EDE, a physician or technician inserts a very fine needle,
which serves as an electrode, through the skin into the muscle.
With the electrode in place, the patient is asked to slowly contract
the muscle—for example, by bending the arm—with gradually
increasing force, while the electrical activity is being recorded. The
activity can be displayed visually on an oscilloscope or screen, or
played audibly through a speaker. The results can provide
information about the ability of the muscle to respond to nerve
stimulation.
REFERENCE:
https://www.homeceuconnection.com/blog/hydrotherapy-treatment-
benefits-types-contraindications/
https://swrwoundcareprogram.ca/Uploads/ContentDocuments/Ultrav
ioletCTherapy.pdf
https://www.bestresultspt.com/iontophoresis-iopp/
DE LISA
BRADDOM