EXERCISE IN THE WATER ENVIRONMENT

Water is an excellent medium for exercise because of the reduced gravitational forces experienced by the body when partially submerged. This provides a low impact alternative to land-based exercise programs.

A person who is vertically immersed up to neck level in water experiences an approximate 90% reduction in gravitational forces. Risk of injury is minimized because there are fewer shear forces acting on the spine. The buoyancy, support and accommodating resistance of water enhances exercise and creates a safe environment for progress toward exercise goals.

When exercising in a warm water pool (85 degrees), the temperature of the water promotes muscle relaxation, facilitates stretch and generally reduces the sensation of pain.

Pool exercise can improve circulation, strength and endurance, balance and coordination; increase range of motion; decrease tissue swelling; normalize muscle tone; protect joints during exercise, and reduce stress. Swimming engages practically all muscle groups of the body.

Water exercises also greatly benefit the pregnant woman. For every change occurring in the pregnant woman’s body, water exercise and swimming can help the body adapt to carrying the baby and alleviate common discomforts, while preparing the muscles for childbirth. A regular water fitness program will equip the heart and circulatory systems to handle the 25% – 50% increase in the blood supply to the pregnant body. Water fitness can also help reduce blood pressure by causing the body to naturally rid itself of excess water and salt.

Between 50% and 75% of women report low back pain or pelvic pain during pregnancy. Changes in joint laxity may contribute to this phenomenon, as well as the concentration of the hormone relaxin. Weight gain and abdominal weakness play contributing roles also. Aquatic exercises reduce gravity forces, reduce muscle tone that can help increase space between vertebrae and decrease nerve compression. The result is less muscle contraction and pain.

Aquatic Physical Therapy is the practice of physical therapy by a trained and licensed physical therapist within the environment of a water-filled pool. Typical problems and conditions that can be treated effectively through aquatic physical therapy techniques are injuries to the neck, shoulder, low back, knee and ankle, chronic pain, arthritis, fibromyalgia, neurological disorders and conditions limiting the body’s ability to bear weight. An electric lift chair allows treatment to be given to those whose mobility is significantly impaired, including wheelchair bound patients.

Whether through medically prescribed Physical Therapy, supervised exercise classes, or independent workouts, exercise in the water provides an excellent environment for safe fitness and rehab activities.

Women and the Water Workout
(Can You Sweat When You’re Wet?)

Exercise in the water provides an excellent environment for safe fitness activities. Reduced gravitational forces are experienced by the body when partially submerged, allowing a low impact alternative to traditional exercise programs. Pool exercise can improve circulation, strength and endurance, balance and coordination, and range of motion. It can also decrease tissue swelling, normalize muscle tone, protect joints during exercise and reduce stress.

Women and their unique health concerns can particularly benefit from exercise in the water environment. During pregnancy, the pressure exerted by the water at the feet when working in chest deep water helps to decrease lower leg swelling. Reports of low back pain are often reduced when exercising in a warm water pool. The pelvic floor muscles tend to relax, and balance can be improved. The expectant mom should never exercise in water over 93.2 degrees Fahrenheit.

The female athlete can perform sport-specific exercises during training. If rehabilitating an injury, activity in the water can be begun earlier than land-based exercises. Weight-bearing on injured lower extremities can start prior to tolerance of similar programs on land.

Breast cancer and lymphedema that often follows surgery can be addressed with aquatic activities. Early shoulder motion can occur in a more pain-free situation, and relaxation and stress management are also noted. Lymphedema decreases because of the water’s hydrostatic pressure. Enhancing the cardiovascular system activity also enhances lymph flow.

Osteopenia and osteoporosis can be addressed by improving balance, decreasing fall risk, improving range of motion, increasing activity levels and correcting common postural problems with retraining. Studies have shown water exercises to have a suppressive effect on bone loss, although no specific bone density increase was found.

Fibromyalgia patients exercising in 88 to 94 degree water can expect an increase in relaxation and body awareness. Aerobic activity is encouraged, and the social interaction of a group exercise setting is beneficial.

Women with multiple sclerosis should keep to cooler water (85 degrees). Exercises should concentrate on those to aid balance deficits, muscular weakness and fatigue.

Women in the middle years and beyond often report an improved quality of life, especially when other medical conditions make land exercise difficult. Exercise in the water is a “safe” environment, and may encourage women to be more fitness minded. Long-term exercise involvement may be more appealing in the warm water.

Although aquatic exercise is definitely beneficial for people of all ages and both sexes, women and their unique health concerns may find a particular good “fit” in the warm water pool.

Aquatic Therapy and Pregnancy

Aquatic therapy is an excellent addition to traditional rehab due to the unique properties of water and by providing a safe and supportive environment to encourage functional movements.

Many of the benefits of aquatic therapy are universal, including cardiovascular health, weight reduction, and increased energy. Others are specific to, or are vastly important for women who are expecting. For example, breast growth and abdominal expansion shift a woman’s center of gravity forward making back pain and sciatica more prevalent. Hormonal changes result in greater laxity of joints increasing risk of injury. The zero impact of exercising in water alleviates both conditions.

Aquatic therapy also helps reduce water retention both by metabolizing calories and by hydrostatic pressure.

Hydrostatic pressure helps in altering the body and assists in increasing circulation and ease of movement.

If the mom is tired and has experienced difficulty sleeping the warm water and flowing movements are beneficial. Expectant moms report their babies become quieter and more peaceful too.

Differential Diagnosis of Common Back Conditions

Many of us at one point have complained of back pain, whether it is something simple as a sore back, or as debilitating as suffering from chronic neurological symptoms down one or both legs. The likelihood of a person having ever complained of back pain is fairly high in the United States. A recent survey from the American College of Sports Medicine (ACSM) concluded that 80% of Americans at some point in their life will suffer from back pain. The purpose of this article is to give the reader a better understanding of different diagnoses made in relation to common complaints that people who suffer from back pain may have.

Ankylosing Spondylitis is a rheumatic disease which can cause chronic inflammation of the spine and sacroiliac joints. Thought to be an inherited disease, Ankylosing Spondylitis can affect people of all ages. Ankylosing Spondylitis is two to three times more common in men than women. Some common complaints include pain, which may vary from a dull ache to sharp pain, morning stiffness, fatigue, and a decrease in spinal mobility. Plain films such as x-rays may be used in order to diagnose this condition, as well as blood tests.

Spinal Stenosis is a condition which involves the narrowing of the spinal canal or the intervertebral foramen. This narrowing can put pressure on the spinal cord or on the nerves that branch out from the compressed areas. Depending on the nerves affected, Spinal Stenosis can cause cramping, pain, or numbness in the legs, as well as pain located at both sides of the back. Diagnostic tests utilized include x-rays, MRI, and/or CAT scan.

Lumbar Strain/Sprain is perhaps the most common cause of low back pain. A muscle strain occurs when the muscle fibers are abnormally stretched or torn. A sprain occurs when the ligaments of the spine are torn. Lumbar Strains/Sprains may be caused by sudden trauma such as an automobile accident, improper lifting techniques such as bending forward to lift heavy objects, or poor body mechanics such as repetitive twisting of the spine to move items from one location to another. The most common symptoms of this condition include pain which may refer to the buttocks, low back muscle spasms, and a decrease in lumbar spine mobility. Neurological signs and symptoms are typically nonexistent with this diagnosis. Diagnosis is made by clinical examination comparing results of flexibility, resistive tests, and palpation.

Physical Therapy can help with each of these back conditions in order to decrease pain and increase functional mobility. The treatment strategy will be dependent on a patient’s diagnosis. Treatment plans will vary and may include options such as soft tissue mobilization to decrease back spasms, electrical therapy to decrease pain, manual techniques to increase joint mobility, therapeutic/aquatic exercises to increase both strength and flexibility, and patient education on proper posture and lifting techniques. As always, consult your physician before beginning any type of treatment. Your physician will be able to determine what treatment approach will be best suited for you.

What is Lymphedema?

What causes Lymphedema?

What are my lymph nodes and where are they?

Why did I get Lymphedema?

How is Lymphedema different from other swelling?

How do I know if this is Lymphedema?

Is Lymphedema curable?

Management of Lymphedema

Lymphedema is the swelling of a limb or body part that is caused by a problem in the lymphatic system preventing the normal transport of lymphatic fluid back into the circulatory system. Causes of lymphedema include trauma to the lymphatic system from surgery or radiation to treat cancer, damage from accidents, chronic inflammation or infection that damages the lymphatics. Cancer cells may block vessels, or parasites or other foreign material can also impede the lymphatics. In the United States there are between two and eight million people affected with lymphedema.

The lymphatic system is responsible for removing wastes not removed by the blood circulation, and taking these wastes to larger blood vessels for disposal. Lymph fluid is a clear and slightly sticky liquid made up of protein molecules, water, bits of dead cells, and foreign cells such as bacteria, viruses, fungus cells and anything else not belonging in the body.

Lymph nodes are located along the lymph vessels and have several jobs. They identify things that don’t belong in the body (such as bacteria or viruses), and make special cells to fight these invaders, thus beginning the immune response. They also store things that should not be in the body, such as coal dust or cancer cells. The lymph nodes also remove a portion of the water from lymph fluid.

The effects of lymphedema are not just cosmetic. A swollen limb can impede clothing from fitting, sometimes preventing a post-mastectomy patient from wearing long-sleeved blouses. In addition, other limitations can include weakness, loss of range of motion, debilitating pain, altered sensation, and problems with functional activities.

The current standard of treatment for lymphedema is called “Complex or Complete Decongestive Therapy,” and has been the recommended protocol in Europe since 1995 and in the U.S. since l998. Complex Decongestive Therapy (CDT) is a multiple modality treatment that comprises ALL of the following:

• Manual Lymph Drainage
• Compression therapy (bandage systems, compression garments, manually-adjustable compression devices)
• Lymph stimulating exercises while under compression
• Meticulous skin care

Treatment is administered by a specially trained medial practitioner, usually a Physical Therapist, and is utilized in a two phase program. Phase 1 consists of a specialized massage technique to open lymphatics and increase flow, followed by medical compression bandaging. Phase 2 consists of all the components of Phase 1 with the addition of exercises to increase lymph flow. Heavy emphasis in this phase is on patient education to become independent in self care.

Compression pumps or Jobst pumps are no longer used. Most research points to these having adverse effects and possibly damaging initial lymphatics.

What is Fibromyalgia?

The name "fibromyalgia" has largely replaced the term "fibrositis", which was once used to describe this disorder. The "itis" means "inflammation"--a body process that can result in pain, swelling, warmth, redness, and stiffness. Early reports of this condition described inflammation in muscles. However, during the past 50 years, investigators have proven that inflammation is not a significant part of fibromyalgia.

Fibromyalgia is a form of "soft-tissue" or muscular rheumatism rather than "arthritis of a joint". The word "rheumatism" refers to pain and stiffness associated with arthritis and related disorders of the joints, muscles, and bones. Fibromyalgia mainly affects muscles and their attachments to bones. Therefore, although fibromyalgia may feel like a joint disease, it is not a true form of arthritis and does not cause deformities of the joints.

Unfortunately, because certain syndromes lack physical and laboratory findings (signs), but depend mostly on a person's report of complaints and feelings (symptoms), these syndromes are often viewed as not being real or important. In the past, fibromyalgia suffered from this type of negative thinking.

Over the past 10 years, however, fibromyalgia has been better defined through studies that have established guides for its diagnosis. These studies have shown that certain complaints, such as generalized muscular pain and tender points, are present in people with fibromyalgia and not commonly present in healthy people or people with other rheumatic conditions. These diagnostic features separate fibromyalgia from other types of conditions that have chronic muscle and bone pain.

Coping with Fibromyalgia

You and your family should understand that fibromyalgia is a real cause of chronic pain and fatigue and must be dealt with as with any chronic illness. Yet, fibromyalgia is not life-threatening and causes no deformity. Although symptoms may vary, the overall condition rarely worsens over time.

Often, just knowing fibromyalgia is not a progressive, crippling disease allows people to stop additional expensive testing and develop a more positive attitude toward their condition. Relaxation techniques, such as meditation, visual imagery, progressive muscle relaxation, yoga, or bio-feedback may also be helpful. You should examine your own sleep patterns and avoid aggravating factors such as excess caffeine and alcohol. If you feel depressed or very anxious, it is important to get help from a mental health professional. The more you learn about your condition, and the more you take an active role in finding the best means to lessen your symptoms, the better the outcome.

Support groups and educational classes organized by the Arthritis Foundation have been a source of help for many people with fibromyalgia. Just knowing that you are not alone can be a source of support.

Some people with Fibromyalgis have such severe symptoms that they are unable to function well at work or socially. These individuals may require greater attention in program that employs physical or occupational therapists, medical social workers, rheumatology nurses, mental health professionals, rehabilitation counselors, and seep specialists.

Benefits for Using Cryotherapy

The beneficial effects of Cryotherapy include:

• Reduce pain
• Reduced muscle spasm
• Reduced inflammation, swelling, and tissue bleeding
• Reduced/preventing secondary tissue damage and tissue scarring

1. Do not apply directly to the skin – place a light towel between the skin and pack. The use of any cold therapy can result in a skin burn.
2. Do not use if frozen solid.
3. Use a blanket or extra clothing over the body if the cold causes generalized chilling.
4. Do not use while sleep
5. Do not use for more than 20 minutes every 2 hours. Have the patient use the cold pack for shorter periods of time until tolerance to the cold is established.
6. Children and the elderly have a lower tolerance to cold and may need to apply it for shorter periods of time.
7. Do not use if circulatory problems exist.
8. Do not use on open wounds.
9. Do not use as a hot pack. Do not microwave.
10. Discard if punctured. Contents are non-toxic.