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by Federico Coppini

By Malini Chaudhri. Ph.D L.Ac. Sports Massage (USA). Accredited course provider from Center for Wellness. Delhi.

The use of water as a healing agent is centuries old. Recent times have seen the rise of modernized equipment and ambience in spa or clinical settings with scientific control and trained personnel. However, understanding the principles of hydrotherapy in its basic applications of heat, ice and liquid will support home based wellness for the tennis player and an ideal regiment which may be enjoyable and relaxing in its varied end styles.

Water essentially may be heated to 100 C to form vapor, frozen at 0 C to form ice or found in its liquid state. Vapor expands the liquid molecules whereas ice condenses it. In its liquid state it may be combined with chemicals and transformed in its properties. All applications may be seen effectively in steam sauna units, tub baths and their variations and chill pools or ice therapy 



The skin is the ‘vegetative nervous sense organ’. Water can account for a heat loss twenty-five times greater than possible through air. Stimuli that act on the skin travel from the skin receptors through the segmental reflex (consensual reaction) to the other side of the body, but also through the autonomic centers of the central nervous system (enlarged or distant consensual reaction).

The cold receptors are more frequent in the skin than the heat receptors; for example, in the face ratio is 11.3 as against 3.3 per square centimeter for heat and even in the trunk the ratio is 9.7 for the cold as against 0.6 per square centimeter for the heat.

Hydrotherapy uses the principle of Telereaction - where the segmental blood shift that follows cold stimulation of the skin is reflected in the other corresponding side (segmental reflex) and elsewhere in the body - brain vessels, pharynx, coronary vessels, and kidneys. This may be noticed in a warm foot bath which warms up the entire body.

Another applied principle is known as the Dastre-Morat law, where an increase in the cutaneous circulation also involves the neighboring muscles with a shift from the interior (lungs and abdominal cavity). No other method is known that will increase the circulation so much with so mild a lasting and physiologic effect as hydrotherapy.

Brief hydrotherapy applications to a warm body segment will (a) shift blood from the interior to the skin segment (b) increase the general metabolism, particularly of the muscles and liver, through the central heat regulator (c) increase general and cardiac muscle tone and minute cardiac volume with lessened pulse rate (d) reinforce breathing by deepening respiration (e) regulate general excitability of the nerves and (f) increase resistance to the common cold.

Ice for pain control and inflammation may be applied to an injured body area. This s known as Cryotherapy

In case of decreased nerve conduction velocity and pain, cryotherapy slows the rate at which nerve impulses are propagated along a peripheral nerve. The slowing of this impulse affects both sensory and motor signals in the nerve. One of the most effective uses of cryotherapy, and the reason for its implementation, is the effect it has on reducing pain sensations through decreased nerve conduction velocity.

One way that reduced nerve conduction velocity is used in a therapeutic setting is reducing the stretch reflex, also called the myotatic reflex. The stretch reflex is activated by the muscle spindles when they are stretched either too far or too fast (such as in an acute whiplash). Overstretching a hypertonic muscle can also activate the muscle spindles, causing increased muscle tension. Cryotherapy can decrease the activation of the muscle spindles, which is a benefit for stretching. It can be applied intermittently in strokes to soft tissue massage

In the case of decreased circulation, in response to cold sensations, the smooth muscle cells in the walls of the superficial blood vessels contract and vasoconstrict. Vasoconstriction with cold applications is more pronounced in some regions of the body, such as the distal extremities. The effect of reducing circulation is a physiological effect of ice that may not be desirable. In this case heat and ice must be contrasted and combined in alternating applications to increase circulation.

Edema also limits movement in the region and reduces the likelihood of further injury. Edema also increases our sensitivity to pain from pressure on the pain receptors. Cold application numbs the pain However reducing circulation through cold applications also slows down lymphatic drainage and may actually have another detrimental effect on the tissue repair process as a result. Again hot and cold contrast therapy is needed to move the metabolic lymphatic waste.

Water can be applied in any of its three physical states ( steam, liquid, or solid) or in any combination of them. Because of its high specific heat and versatility, it is an excellent medium for conductive heating or cooling since it absorbs and gives off heat slowly. While an air environmental temperature of 27C/80F is comfortable for the nude body, a water environment of the same temperature is cool. For most people, the critical level of temperature sensation is about 34C/93F - the average temperature of the skin. Hot and cold are therefore relative terms.

Hot water (up to 40C/104F) has an initial stimulating effect, but, as the body recovers from the first response to immersion at this temperature, there is a general and muscular relaxation.

Cold water, on the other hand, may cause some shivering, goose flesh, increased pulse and respiration, dilation of blood vessels, increased muscle tone and metabolism; these are the responses of most healthy individuals. This may be called ‘a tonic’ stimulating reaction to cold as compared with the ‘atonic’ response to heat. The response to hot or cold water varies with the length of application. Cold may be invigorating when used for a short period but is damaging over a longer period. Even in local applications (ice water) the hand may be able to tolerate exposure for more than a minute or two. The skin finds prolonged exposure at 40C/104F uncomfortable for more than a few minutes; water at 50C/102F may destroy mucosa in a short application and skin in a few minutes.


Hydrotherapy is the external application of water for therapeutic purposes. The body or any of its parts may be immersed in the water or the water may be applied to the surface with or without the intermediary of absorbent materials. Hydrotherapy should be used safely without causing frostbite or burns with a clear objective as relaxation, detoxification, anti stiffness, pain control or other. In prescribing hydrotherapy, it should be specified by:
- type
- temperature
- duration and
- frequency

Common examples

Hot Bath: An immersion bath with the water temperature ranging between 35C /96F and 40C/105F feels decidedly hot. At such temperatures loss of heat from the body's surface is stopped, except from the protruding head. At the same time, the body is heated by conduction and therefore the temperature of the entire body will rise. The immersion bath is a rapid means of producing artificial fever. Its efficiency is so great that it may prove a dangerous method for the maintenance of prolonged temperature elevation. Short periods of immersion may cause comparatively little dislocation of the temperature level. Baths lasting two to fifteen minutes are employed in the treatment of chronic rheumatic manifestations in joints, fibrous tissue and muscles; for the relief of muscle spasm, and of colic in the gastric, intestinal, gall bladder, or urinary tracts.

Excellent results are obtained by hot water baths in clients suffering from chronic arthritis. It is recommended that the client be placed in a tub with the water at about body temperature. After immersion the temperature is increased to the point at which it produces maximum muscle relaxation (about 38C /101F to 40C/104F); it is then gradually lowered to the level found most comfortable for the client (between 35C/96F and 36C/98F). Underwater massage should be applied while the client is in the tub; motion should also be encouraged; first passive, then active and later resistive. Because of its severity, this type of bath should not be administered to clients with diseases, such as those involving the heart and arteries or the central nervous system.

Cold Bath: A cold immersion bath whose temperature varies from 10C/50F to 21C/70F may be used, but for very short periods of time (four seconds to three minutes) during which the body should be briskly rubbed by the client himself or by an attendant. After the bath, the client should be briskly rubbed with a towel and dried quickly. Because of the vigorous reaction which it produces, this bath should be given only to robust individuals. In such persons, it causes a feeling of general exhilaration; the circulation becomes more rapid and the appetite is stimulated. If chills develop, the client should be promptly removed from the bath. The cold bath is used as a metabolic stimulant, for obesity, and for atonic states

Contrast Bath: One way to influence the peripheral circulation is by applying evocative stimuli to the skin. One of the simplest methods is by surrounding parts of the body with water at different temperatures. 

A contrast bath consists of two water containers, each large enough to hold two legs. Into one container is poured enough cold water to cover the immersed leg, and the other container is filled with hot water. Since the total duration of treatment is relatively short, thermostatic control of the water temperature is not required. The cold water may be held at a level of about 10C/50F to 16C/61F and the hot water at 38C/100F to 44C/111F.
The leg or legs are first placed in the hot water for four to six minutes and then at once in the cold water for one to two minutes. For the client to end treatment with a feeling of comfort, the final immersion should be in the hot water. Contrast baths are used to stimulate local circulation in limbs without obstructive vascular pathology.

Brine or Salt Bath: Brine waters occur naturally at certain spas. Artificial brine baths can be made by adding from five to eight pounds of sodium chloride to 40 gallons of water. The temperature of the water should be between 32C/90F and 40C/105F; the duration of the bath, 10-20 minutes. These are well known for detoxification. Baking soda and essential oils can be added for multiple benefits

Ice therapy should be used till numbness stage within five to fifteen minutes



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