Hydrotherapy/Hot bath & Hypermobility

[Sez]

I had a hydro session this morning and was told by the therapist that they are planning to start a "Hypermobility" session, specifically for those of us diagnosed as hypermobile and HMS.

Just thought it was worth mentioning Does anyone else attend James Cook Uni hospital in M'bro for hydro?

[Guest]

Hi Sez

Am down near London, so a no to attending the same place as you!

But I do have a question, and sorry to sound a bit thick .... but what exactly does Hydrotherapy physio entail?

Read a lot about people commenting about how it works for them, but what exactly do you "get up to" when attending these sessions?

Foxy

[Sez]

At the start of my sessions, I walk backwards, forwards and sideways along the wall (hanging on for dear life!). It's such a strange sensation to really walk in the water, rather than limp or hobble, and my muscles always feel so sore and tired when I come out.

After this, I do specific exercises for whatever hurts worst that day, so today I did back and hips. I had to stand with my side to the wall, holding on with one hand, and raise the leg away from the wall a little out to the side, then bring it back to straight. I do this 20 times then turn around and do the other side. Then I stand facing the wall, and lift my leg from the hip out behind me a little. I'm always being reminded to just move until I feel the muscles are working, not to move through my entire range! I do this for each leg (around 20 time each again).

Following this, I use a little float, holding it with my arms virtually straight from the shoulders, and so the float is under the water level, and pull it towards my chest, then push it out again carefully. It's so easy to forget to pay attention to the joints because of the water protecting me, so I often over-straighten my elbows and the therapist always notices . I do this a few times, then using foam barbells, I hold them out to the sides and push down just until I feel the water resistance, then release and let them come back up again.

And that's usually me done. The whole session lasts around 15-20 minutes, but as I start to climb out of the pool, gravity gradually takes hold again and it feels really strange to suddenly have to think about holding up your own body again! Would be nice to be able to stay in the water all the time! The other down side is that the pool is so warm that the "outside world" is suddenly very cold, and I went shivering to the shower today. As usual, I had the shower on as hot as it would go to try and take the chill out of my joints.

Hydro sessions are very personal though, and although there's a group of us, the therapist goes round and gives us all one-to-one attention and exercises specifically for us.

[Guest]

Thanks Sez, you're a star

At least now I know what I would be getting myself in for should they suggest this for me at physio when I start. It sounds very much like very gentle aerobics in water so that you're weightless and less stress on the joints. I think I might suggest it myself if they don't.

On the topic of Physio, I mentioned (in the rant room before wipe-out again) about 2/3 weeks ago about my doctors not sending off the referral properly. Well the lovely physio dept have "bumped me" up the list after acknowledging the fact I was referred back in July but they never received it.
When asking for the physio I was recommended I could hear the guy on the phone chatting to department manager, I have already been allocated a Physio and it wasn't this guy who I have been told is aware of HMS. Anyway after a little chat they told me that the physio I have already been allocated is aware of my condition. This all sounds promising, but I am worried that being aware of HMS is not the same as actually knowing the best way to treat it

Anyone got any suggestions how I approach my first physio session ).

[Guest]

I take hydrotherapy, but we call it water arobics. When i'm in i feel...... like a bird or somthing free and weightless. sometimes instead fo the session i just swim around and its sooo great, but then there the part when my mom[mum] says to get out and i just get so sad. I can no longer pull myself out of the pool and i need assitance[more than my grandmother] which is sad and then when i get half way out i stop as i feel the gravity as well and then my mom[mum] puts her arms under my armpit and pulls me up. I personally thank her for that and dont know what i would do without her. Also a bit off subject but to helo me when im not able to get upmy mom[mum] grabs my jean hoops [the place where the belt goes] and pulls me up. Its funny but really works.

[Guest]

Warm up
water walking
As the body moves forward through the water a pressure wave builds up in front and, the faster the pace, the more effort is needed to overcome it. With EDS/HMS patients walking fast, using short precise steps is preferable, avoiding hyperextension at hip or knee. Emphasis should be placed on controlling the legs and not allowing "Wobble" at the hip of either the moving or standing leg. Tile lines are useful here, as the patient can concentrate on moving straight down the line, and not allowing any deviation to either side. As strengh and balance improve, speed can be increased and the hydropherapist can add turbulance, while encouraging the keeping of a straight course against the uneven flow of water.

Brisk sideways walking works hip abductors and adductors. Here the point to watch is that the patients pelvis and toes face sqaure on to the wall, so there is true abduction and adduction, not flexion, taking place at the hips. Small range, moving fast works best, and the ankle of the moving leg is everted as the leg is pushed out, inverted as it pulls in, to prevent passive overstraining of the ankles by flow of the water.

Exercises

Hip flexors and extensors

A) Isometric. Standing chest deep in water, holding rail for balance. Swing one leg briskly backwards and forwards, in a small range, keeping the knee straight, but not hyperextended. Make sure there is no "wobble" on standing or moving the leg.

B) Static. Lying. fully supported, on bed, small ring around thigh. push down against resistance of float, hold for count of 10, and relax. To increase the work use a larger ring around thigh,a s moving the ring to the ankle to lengthen the lever, as would be usual will force the knee into hyperextension.

Knee flexors and extensors

A) Isometric. Standing chest deep in water, holding rail. Flex and extend one knee briskly, avoiding hypermobile range.

B) Static. Quads:-
Standing facing the wall, inclined at an angle of 45º, with float around ankle, and knee bent (Avoid forcible flexion of knee by float) Extend knee against float, hold for counts of 10, relax.

Hamstrings:-
Sitting with one knee extended, and float around ankle (Again avoid forcible extension of knee by float) Bend knee against resistance of float, hold for count of 10, relax.

With the patient sitting up to her neck in the water, shoulder flexors and extensors, ab and adductors, elbows and wrists can be worked in the same way, using small range free exercises pushing strongly through the water, followed by static holds against the buoyancy of a float. Shoulder rotators can be worked with the patient sitting, elbows bent to 90º, and held into the waist, while the hands move in and out. Towards and away from the midline. As the shoulders become more stable it may be possible to use plastic hand paddles to increase the resistance. The ones with wide straps over wrists and hands are preferable, as they support the wrists in the flow of the water.

Cool down period
Stabilising exercises
Many EDS/HMS patients have hypermobile cervical vertebrae, and are unhappy about using a head collar to float as it strains the neck. Always check this, but if they are comfortable in a collar, or confident enough t float without one, effective stabilising exercises can be done in floating. For example, with the patient supine in floats arms abducted, grasping paddles the physiotherapist fixes the hips, and pulls the patient backwards and forwards through the water. While the arm position does not alter. This technique can be adapted to other parts of the body, where the patient hold the join in a fixed position against the turbulence and drag created by the hydrotherapist.

Rhythmic stabilisations can also be performed, using annual resistance, in sitting and standing. The cool-down period could include balance work, such as slow walking, standing on one leg, and slow stepping up and down on small step, with the emphasis on control of the movement and balance. These exercises can be made more difficult by the physiotherapist adding turbulence

[Sez]

Fab - thanks Az!

My hydro sessions are close to an end, so my plan is to buy a couple of floats and go along to local pool when it's quiet and continue by myself. I've not noticed it helping yet, and I don't think ten sessions is enough to be able to tell whether it's having an effect - I wasn't expecting to know if the hydro was helping for at least two or three months. I'll run these exercises past my physio and see what she thinks and see if I can add a few to my normal routine.

[Guest]

Before the "hack-attack" I told in a similar thread how I would be having hydro in my day-care programme, and then how I couldn't start there so wouldn't have it. Well I did get to start there, but the hydro was a bit of a dissapointment to be honest. My (lack of) stability is even worse in the water, and all I was doing was constantly having my shoulders out and trying to get them back in- isn't HMS great fun? Any movement really resulted in yet another sublux, and I think the best way to describe what was happening to my shoulders is to say that they were "all over the place". It was a bit of a shock when my physio said she really wouldn't want me to have hydro in the group anymore, especially as I was the youngest in the group, and somehow I was always thinking how these people with RA and SA really have a serious disorder, and my HMS was just a nuisance compared to that. Well maybe it still is, but in any case I couldn't do the things they could, and instead of two times a week hydro in the group, I now have it one time a week, in a smaller pool, alone with my physio, focused on stability. Well the latter is almost impossible. But in that pool there's a metal bar under the water I can hold to keep my shoulders almost in place, so at least I can exercise my legs without too much trouble. Well as said- it was a bit of a dissapointment. And a shock for me to discover how serious some of my problems are .

[nonyanomemory]

Hi Sententia, I think you have made a really good point, although am a little worried about you right now, will pm you about that. Don't see it as anything other than us lot are so special we get to get the star treatment . My physio felt that unless I had one to one hydrotherapy it could well cause more problems as you have described as in a group the hypermobile body may well be subluxing etc without a the patient realising and b the person running the group noticing. A relative of mine with HEDS was put into a group for lower limb strengthening and in her endevours to be co-operative has caused more injury than one would think possible. In the pain management course I went on I also had to not do the majority of the exercises that were considered suitable for everyone else, despite the fact that they had disabling conditions. So before I go right off topic - if as an hmser you are put into a group for hydrotherapy or otherwise make sure you are getting suitable supervision. nonya

[Guest]

Don't see it as anything other than us lot are so special we get to get the star treatment .

Oooh I think I can do THAT! :twisted:

the hypermobile body may well be subluxing etc without a the patient realising and b the person running the group noticing.

Exactly what was happening! And you are right, you are trying to do all of the exersices as good as it gets, and trying to keep up with the rest of the group, only to notice later what has happened- when you can't sleep at night because of the pain, for example. In fact I was lucky my physio noticed.

[GLYNIS]

When my occupational theropist suggested it my husband made inquires, Where I could go , well none on NHS although some hospitals have one ,Sports clubs do but its very expensive to join if your not using everything even more so. We had to move from my small Hotel which was up for Sale due to heath reasons of course. The one thing on the shopping list out of the procceds of sale was a HYDRO POOL( Ihad used one a few times the relaxation side was well HEAVEN) Going off subject on min or 2 , we are not well off just like every body else mortgage bills ect , and one wage earner,I was going to write about this befor but felt it sounded well umm.. if you know what I mean we are just ordinary you know.

We got one not hot tub but hydro pool with aroma theropy, I use it every day rain shine snow ,

When Im realy bad twice a day sometimes for an hour plus,I feel much better when im in it , the water against my hands , hurts at first but slowly relaxes them , Also I do my excercises in it it takes the weight away from my joints,Only thing is I can stay in it for ever. It realy helps, mentaly aswell,
I know I am very lucky to have one , I wish you could all have one to,

[Mari]

Hello Glynis,
Are you talking about one of those small round things you have in the garden? If so, it's not the same as hydrotherapy in a pool big enough to walk up and down in. You say there are no hydro pools one the NHS, but there are some in the hospitals. Perhaps those are the ones on the NHS? The hydrotherapy pool I used to use was in my local hospital. Could you ask your GP to refer you?

By the way, your pool sounds lovely!

Mari

[GLYNIS]

Our hospital has not got one,Ithink thats what I should have said,We did go to the places that sale hydro pools Ive seen the ones you are talking about with the underwater gym. But they are expensive to say the least this is a smaller version , as like everything else they import them,

[kay]

Hello everyone,

I've finally been given a definate diagnosis of Hypermobility today after 17 long months of maybies and most likelies!

Physiotherapy didn't work for me - it made me worse because it was so strenuous so they have now suggested that I try Hydrotherapy. Does anyone have any positive feedback on this? I've never met anyone who has tried it.

Also, I had an MRI (?) scan where they inject dye into your affected joint(s), did anything show up for anyone who has had this? I must say it was one of the most horrible things I have ever been through!

Bring on the sunshine I'm sick of this rain!
Kay

[Sez]

I went for several weeks of hydro. I enjoyed the sessions, but found I was exhausted afterwards and the warm water made me more prone to subluxations/dislocations afterwards. I eventually stopped going (mostly due to problems and found a great physio who has been a big help. TBH, you might find gentle swimming just as beneficial, but it's definately worth giving hydro a go. I got referred by my rheumatologist.