1. Physical Effects and Medical Efficacy in Medical Hydrology and Hydrotherapy

2. Physical effects of bathing Mechanical effects Thermal effects

3. Mechanical effects of water Buoyancy Hydrostatic pressure (immersion) Viscosity

4. Effect of buoyancy Relaxation Decrease of muscle tension

5. Effect by immersion Half bath Full bath About 1000 ml of blood flows into the thorax Air bath

6. Acute effects of immersion in haemo dynamic function in lung function in kidney function in neuro-muscular function in endocrine function to the blood

7. Effect of immersion Heart rate Blood pressure DivingEffect of stand up

8. Effect 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

9. 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

10. Immersion effect in creatine clearance

11. Effect 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)

12. Effect in neuro muscular function Increase of the muscle relaxation Decrease of the reflective contraction Increase of the mobility Decrease of the oxygen consumption

13. Effect in endocrine function Stimulation of the atrio-natriuretic factors (ANF) Suppression of renin, angiotensin, aldosterone, epinephrine, nephrine l Suppression of ACTH and cortisone l Suppression of adiuretine (ADH) and prolactin l Stimulation of the endogenous dopaminergic and central opioid activity (ß-endorphins)

14. 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)

15. 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.

16. Indications of 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

17. Indications of 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

18. Perception of thermal effects in water Cold: lesser than 32 °C Thermoneutral: 34-35 °C Warm: till 38 °C Hot: more than 38 °C

19. Effect 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

20. Effect of cold bath on epinephrine by Bühring Nephrine 0 200 400 600 ng/l 15 35 36,5 37 o C o C 010203040506070 min. Before 15 o C Erwärmungbis1 o CunterRektaltemperatur Water temperature Body temperature Epinephrine

21. 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 acetylcholine- hyperaemia period is longer. To get this reaction the cold stimulation should be not very strong.

22. 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.

23. 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.

24. Effect of changing cold-hot bathing Thermal stimuli for training of vegetative- hormonal functions – Convalescence – Psycho-vegetative syndrome – Cardio vascular regulation disturbance – Metabolic disorders

25. Effect 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

26. Effect of hot bath on blood circulation by Barcroft 45 40 35 30 25 o C 0102030405060708090100110120 min. 80 60 40 100 % Blood circulation in muscles Water temperature

27. Heart rate in hot baths Heart rate Temperature of water Respiratory minute volume

28. Heat-transfer Moving water: Convection – Quickly heat transfer (stronger temperature sensitivity) Not moved water or mud: Conduction – Slowly heat transfer (lower temperature sensitivity)

29. Heart rate by coldness shock Diving after Sauna in cold water Blood pressure Increase of heart rate Sauna Control

30. Inure 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

31. Inure effect by stimulation of stress-proteins Stress-proteins are produced by – Normal cell grow – Cell division – Grow factors – Cell differentiation

32. Inure effect by stimulation of stress-proteins Stress-proteins are produced by – Diseases – Virus infections – Fever – Inflammations – Circulation disturbances – Hypertrophy – Oxidation – Cancer

33. Inure 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.

34. 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

35. 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

36. Hydrotherapeutic measures Washings Affusions Baths Water stepping Brushings Packs and wraps

37. Holding the tube to prove the water pressure for affusions

38. Knee-affusion

39. Arm-affusion

40. Over-affusion

41. Flash-affusion

42. Upper part washing

43. Lower part washing

44. Putting a wrap

45. Breast-wrap

46. Arm-wrap

47. Wet-socks

48. Lumbar wrap

49. Hay-sack

50. Loam-pack

51. Half-bath

52. Seat-bath

53. Foot-bath

54. Arm-bath

55. Steam-bath

56. Water stepping

57. Hydrotherapy in cardiac-circulation problems 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

58. Hydrotherapy in respiratory problems 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.

59. Hydrotherapy 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

60. Hydrotherapy in disturbances of the abdomen Colic without fever: – Hot packs Kidney-bladder-colic: – Rising hot foot-bath or seat-bath

61. Conclusion 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