Massage to Dry Hydrotherapy:
An Evolution in Physical Therapy

by Leni Nelson

Massage may be defined as manipulation of the tissues of the body for therapeutic purposes. The word itself is taken from a root meaning "to knead" or "to handle". Massage is one of the easiest ways of attaining and maintaining good health, and it is something we all do naturally. It is a healing instinct, innate to us all. Use of the word massage is relatively new and probably derives from the Arabic "masah" that means to stroke with the hand.

Massage is an ancient remedy used both by man and animals. Animals instinctively lick their wounds, cleansing and massaging at the same time. Man has doubtlessly used massage of a simple type from prehistoric times. It is known to have been employed in ancient China and India. The earliest mention of massage appears in a Chinese book dating from about 2700 BC "Early morning stroking with the palm of the hand, after the night's sleep, when the blood is rested and the tempers relaxed, protects against colds, keeps the organs supple and prevents minor ailments." It was described by Homer in 1200 BC and by Hippocratic in 460 BC and was used in the Greek and Roman baths. The Roman Emperor's physician, Galen (AD 129-c.199), wrote at least 16 books relating to massage and exercise, and many of his ideas are still relevant today. He describes massage given to the gladiators before and after the games: "they were anointed with oils and rubbed until they were red." In more recent times it was developed to a high degree by Ling of Sweden and Mezger of Holland. Later advocates were Weir Mitchell and Kellogg in the United States and Cyrlax and Mannell in England. In the eighteenth and nineteenth centuries, massage grew in popularity in Europe.

A Swede, Per Henrik Ling (1776-1839), developed a system of massage and gymnastic movements. His work was rewarded by the Crown, an institute was set up in Stockholm, and in 1838 a Swedish institute was opened in London. Within 50 years, such institutes were opened in countries of Russia, France and the United States. Hence the term Swedish Massage, which you will find in use today.

General massage causes an immediate increase in the red blood cell count and hemoglobin that is transient but has a tendency to be more prolonged with repetition. Massages produce muscular relaxation in patients with muscle twitching and spasm. This is common knowledge with physiatrist and physical therapists who deal frequently with this problem. In fibrosis, with its accompanying muscle spasm, heat and massage are standard treatment. Massage is seldom prescribed alone; the usual procedure is heat and massage for its relaxing and analgesic effect. The duration of a massage to a local area may vary from 5-15 minutes. General massage may last from 45 minutes to an hour. Frequency of treatment may range from daily to twice weekly. The dosage and frequency of the massage are based entirely on the individual patient's condition as judged by the attending physician.

Benefits of Heat
Heat has been used for centuries to ease tension and pain of tight and sore muscles. Heat supports the massage action and provides two important benefits to the users. Firstly, heat promotes increased circulation; oxygenated blood and nutrition are delivered to the muscles. Byproducts are removed more effectively, reducing recovery and healing time. Secondly, heat is soothing and relaxing to the biological body and promotes a sense of well-being.

During heat therapy, the blood flow is increased, owing to arteriolar and capillary dilation. The tissue metabolism is initially increased as a result of the temperature elevation. The physiologic effects of heat may be summarized briefly as relief of pain, increase in the arterial blood supply, increased edema because of the increased capillary pressure and softening of fibrous tissue. Heat should always be followed by massage or exercise. Relaxation is best attained by moist heat, followed by massage to stretch the fibrous adhesions as well as to get rid of any edema that may still be present.

Today, with an aging population of Baby Boomers reaching the 50 year mark, again the value of massage is recognized. However, in this busy society of the new millennium, everyone is looking for a quick and convenient method to achieve the beneficial results of massage. Massage can and is frequently being prescribed in conjunction with other medical treatments as a means to attain good health. The therapeutic effect of massage is recognized and the respect it deserves among professional health care providers is currently on the rise.

Hydrotherapy
Hydrotherapy may be defined as the use of water in any of its three forms, solid, liquid or vapor, internally or externally, in the treatment of disease or trauma. The physician who writes the prescription for hydrotherapy or massage must entrust its actual application to the physical therapist who performs or oversees the treatment. Although the administration of hydrotheraputic procedures is not technically difficult, good results are dependent upon meticulous attention to detail. Therefore the therapist should endeavor to develop a faultless technique in both hydrotherapy and massage. The therapist should be aware of the underlying physical and psychological principles of these procedures. They should know the properties of the physical agents they are using, in this instance, water. They need to be familiar with the local and general effects of heat and cold upon the body.

It is a rewarding experience to watch a patient obtain relief from discouragement and pain, and in many cases, recover from disease as a result of the treatment given.

In hydrotherapy, the environment of the body is changed by means of water applied by various mechanical means. Fortunately, water is a versatile therapeutic agent so that the physiological response can be varied at will by changing the temperature and the mechanical impact. It is obvious that very measurable physiological changes can be produced by means of hydrotheraputic procedures.

Physiological changes produced in the body by hydrotheraputic procedures may be classified as thermal, mechanical and chemical. Thermal effects are produced by the application of water at temperatures above or below that of the body. The greater the variation, either above or below the temperature of the body, the greater the physiological effects produced, other factors being equal. The mechanical effects of water upon the body are produced by the impact of the water upon the skin surface in whirlpools, sprays, douches and frictions. The chemical effects of water are produced when taken by mouth. Hydrotherapy and dry hydrotherapy use both chemical and mechanical effects of water in treatment. Heated water is forced against the body either through direct contact or through a barrier.

According to the kinetic theory, heat is defined as kinetic energy of moving particles. Heat is transferred from one object or substance to another, or generated in a substance or tissue by one of the following methods:

Conduction is the method used in hydrotherapy. Heat is transferred by contact with one heated object or substance with another. The contact of water with the body is accomplished by either immersion, packs, or in dry therapy by heated water forced under pressure against the body. The conductive heat of hydrotherapy does not penetrate deeply beneath the skin surface and is confined largely to the skin and subcutaneous tissues.

Unfortunately, there may be some negatives to the use of hydrotherapy treatments. Today, therapists are finding that what is good for the patient is not always healthy for the therapists. The patient receives only the benefits of this therapy due to the short exposure time. However, the therapist is in this environment for long periods of time. According to some specialists in the field, therapists who are in the environment daily may have chronic fatigue, contact dermatitis, sinus problems or respiratory related problems. These are some of the problems resulting from prolonged contact with the water in which patients have been immersed. The air around the pool (spa) area must be kept at high temperatures and holds humidity; this combination helps to create gaseous air pockets. This can lead to some of the above mentioned ailments. Seeking an alternative to wet hydrotherapy is a priority for some therapists.

Uses of Dry Hydrotherapy
Dry Hydrotherapy is a useful piece of equipment, combining all of the previous modalities we have mentioned, massage, heat and water for its therapeutic effects. This is a most asked for modality by patients. The advantages are numerous. One of the most important is patient comfort, as there is no need to disrobe. This immediately relaxes the patient. A large majority of patients receiving treatments are elderly or disabled. With dry hydrotherapy, there is less possibility of accidents from slipping and the difficulty of entering and exiting the tanks. Many systems are waist high, where the patient walks up, sits and swings their body onto the bed. Sanitation is not a problem and dry hydrotherapy averages 15-20 minutes per session allowing three patients per hour. Should space be a problem, a treatment room need only be 8' X 8' with only an electrical outlet. Some Dry Hydrotherapy equipment may require special preparations, so check with the individual manufacturer.

Different groups are discovering the benefits of Dry Hydrotherapy, in particular, the professional sports arena. Pro-atheletes often suffer from muscle spasms during workouts and games. When this occurs during workouts, it may cause a disruption in both their physical and mental preparation for competition. Obviously, occurrences during actual games are devastating for the player and often the entire team. Training centers that provide dry hydrotherapy equipment for their athletes find that a session on the bed will relieve this problem. Good as new, they are ready to return to practice with very little time away from the training. Sports medicine is a growing business for physical medicine treatments. Other areas choosing dry hydrotherapy are nursing homes. Many elderly patients show no desire or willingness to participate in any form of physical activity. The benefits of passive massage they receive allows the physical therapist to complete their treatment. They show a marked increase in mobility after the treatment. A new idea for placement of dry hydrotherapy units is birthing centers. Women giving birth have always benefited from the soothing effects of heat and massage. Dry hydrotherapy is an excellent treatment for women in labor.

How does this therapy enhance the physical therapist efforts to offer a complete treatment to their patients? Relaxation is important to the therapy's success. If a patient is tense and shows no trust in the procedure, he/she will certainly not receive the full benefit of any treatment. Before starting any procedure, try a session on a dry hydrotherapy bed and see the difference. This is an unattended therapy that will allow the therapist extra time to prepare for the following treatment.

This information has taken you from the ancient Chinese to the technology of today. We hope it has given you an understanding of the evolution to dry hydrotherapy and the benefits resulting from this therapy.

Click here to see a short video about the Ocean Wave Massage Bed.