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Topik 2:Whirlpool and Contrast Bath
NP1163: ELECTROPHYSICAL AGENT
Dr. Hafifi, Physiotherapy, FSK, UKM
1

Learning outcomes
• At the end of the lecture, students should be able to
• Identify the physical properties and the physiological responses of
whirlpool and contrast bath
• Analyse the physiological responses of whirlpool and contrast bath to
promote healing
• Assess the indications, contraindications, and precautions of whirlpool and
contrast bath
2023 NP 1163 EPA Whirlpool 2

Introduction
• The whirlpool bath is a huge tub that is filled up with water. The body part
that is to be treated is then positioned in the tub of water, and a small
motor foments the water. While in the water, you can move your body part
to assist with working on the movement around the injured area.
• Therapeutic stainless steel, fiberglass, or plastic tank that uses turbines to
agitate and aerate water into which the body, or part parts of it, is
immersed.
• Tanks come in different sizes to accommodate the treatment of different
body parts
• it tends to be made in any size tub or tank, making it possible to submerge
the entire body for a hydro-massage effect.

Temperature
• The temperature of the water in the whirlpool can be warm or cold, depending
upon the ideal objective
• The commonplace temperature of a warm whirlpool is 98-110 degrees
Fahrenheit. Care should be taken to keep away from consumption.
• Warm whirlpools can increase circulation, as the intensity assists with opening
up little veins in the body. Expanded flow can bring new blood, oxygen, and cells
to the injured region, which can promote healing.
• A cold whirlpool is normally between 50 to 60 degrees Fahrenheit.
• Cold whirlpools cause the arteries in the body close, which can assist with
diminishing flow to the body part being treated. This is utilized to manage
inflammation and swelling in the harmed body part.
• A common whirlpool treatment goes on for 10 to 15 minutes. Your physical
therapist might have you play out specific exercises while your body part is in the
whirlpool to assist with working on the scope of movement in the part being.

Types of Whirlpool bath

Low boy tank:
the low boy tank can be utilized to permit an adult to sit in the tank and can go in the limit from
75 to 105 gallons.

High boy tank:
Now and then referred to as a hip or leg tank, can permit immersion of both lower
extremities. The limit can go from 60 to 105 gallons.

Hubbard tank:
• A tank of reasonable size and shape for use in dynamic or passive submerged
exercises.
• It is additionally utilized for the debridement of burns and different injuries.
• The Hubbard tank has a more prominent potential for exercise during treatment
because of its size and can accommodate a full body treatment limit and can run
any place ranging from 200 gallons, excess to 400 gallons.
• figure 8 example:- the example can permit simple access to the patient. note
that the bigger tanks additionally have more than one turbine for agitation.
• butterfly shape:- submerged exercises 8 feet in length, 6 feet wide,4 feet down
425 gallons of water stretcher, turbines, hoist chances of tainting costly
optional to measure of water, time to clean.

Extremity tank
the extremity tank is usually utilized for the upper or lower extremities and has a limit
of 10 to 45 gallons of water.

Therapeutic effects of whirlpool bath
• The whirlpool bath joins the values of conductive intensity and gentle massage.
• The hydro-massage effect achieves the following Therapeutic Effects:
 A soothing activity.
 A help of torment by improvements which act through the agony
walk instrument.
 An unwinding of muscle fits.

Goals of Whirlpool Therapy
The typical goals of whirlpool use in the physical therapy clinic include:
 Decrease swelling
 Control inflammation
 Promote wound healing
 Improve motion
 Decrease pain
 Decrease muscle spasms

Common injuries and conditions that may be treated with whirlpool
therapy include:
 Ankle fracture
 Plantar fasciitis
 Lisfranc dislocation
 Colles’ and Smith’s fractures
 Tennis elbow
 Achilles tendon rupture and tendinitis etc.

Uses of whirlpool bath
 burns if no agitation is used.
 open wounds for debridement purposes.
 post-operative orthopedic conditions where the water will add a
buoyancy element to eliminate the weight of the extremity for
movement.
 as a resistance force for exercise.

Actions
 producing vasodilatation.
 improve local arterial and lymphatic circulation.
 softening of scar tissue.
 breaking down old adhesions after fractures or sprains.
 mechanically removing dirt, dead tissue, and puss.
 causing regression of the inflammatory process.

Indications of whirlpool bath
 Poor circulation
 Chronic edema
 Separate dead tissue
 Pain relief in amputations ( phantom pain)
 After removal of plaster cast (fractures)
 Stiff joints
 Arthritis with stiff and swollen joints
 Poliomyelitis and paraplegia to improve circulation
 Traumatic and chronic inflammatory conditions
 Weak and painful feet
 As preparation for massage, passive stretching, and
exercise

Contraindications of whirlpool bath
 Diabetes mellitus
 Varicose veins
 Advanced arteriosclerosis
 Advanced peripheral vascular diseases
 feverish patient
 recent skin grafts
 circulatory impairment
 active bleeding
 open wounds
 hemorrhage
 skin allergy

Contraindications
 Maceration around wound
 it is likely to increase the maceration and thus increase
the size of the wound.
Note : non-immersion technique should be used to avoid excessive or prolonged
soaking of macerated tissues.
 Bleeding
 may increased bleeding by increasing venous circulation as a
result of hydrostatic pressure
 may increase arterial circulation as result of vasodilatation if
warm or hot water is used
Note : nonimmersion technique should be used if bleeding is mild

 Impaired thermal sensation
 increased risk for burn.
 To minimize burn — check water with thermometer before
treatment part is immersed.
 the thermostat controlled mixing valves should also be used to
control the temp. of incoming water.
Assess : thermal sensation by applying hot and cold test.
 Incontinence of bowel or bladder
 Unstable BP
 Uncontrolled seizure disorders
 Acute febrile illness
 Infectious disease
Other contraindications

Patient with confusion or impaired cognition
Assess :
 Pt’s level of cognition and alertness. Check if the
pt can effectively communicate discomfort
 Provide direct supervision throughout treatment if pt unable to
communicate effectively report problems.
Recent skin graft
 graft may not tolerate the mechanical agitation of whirlpool or may not have
sufficient vascular response to compensate for extreme heat or
cold.
 Therefore the whirlpool agitator should always directed away from the area of a
graft, and water with neutral warmth (33 - 35.5°C) or mild warmth (35.5 -
37°C) when treating recent graft.

Beware of any adverse conditions that may appear
 skin pallor
 shivering
 dizziness
 rapid, weak pulse
 headache
 increase in edema
 decrease in range of motion (ROM)
 hyperventilation
 seasickness

Technique of Application
 The whirlpool tank is filled with water.
 The water temperature is checked by hand and thermometer.
 Adjust the patient’s position in accordance with the treated body part
and consider both comfort and security.
 Explain the procedure and reassure the patient.
 Place the body part in the water.
 Encourage the patient to move while keeping the body part under
water during the treatment in case of joint involvement.
 After completion of treatment, dry the body part and wrap it keeping it
warm.

Hot water and cold water mixing valves
 Thermometer for checking the temperature of the
water in the tank.
 turbine to agitate and aerate the water
Preparation of Equipment

Preparation of patient
 Explanation and instruction – as per other heat therapy.
 Allow the patient to undress the area to be treated, and provide a
gown or halter and pants as necessary for modesty.
 Do not allow any clothing to enter the water because may be sucked
into the turbine
 Remove wound dressing if any and if they are easy to
remove without causing pain or damaging the tissue.
 For adhered dressing, may be easier to remove after
brief soaking in the water, but should be done before
the agitator turbine is turned on.

 Position the patient comfortably, with the affected area
immersed in the water.
 Try to avoid pressure of the limb on the edge of the whirlpool in
order to avoid impairing circulation or nerve function or causing
discomfort.
 Dry padding, such as folded towel, may be placed on the rim
of the tank to distribute pressure. Do not allow the patient’s
fingers or toes to be near the turbine ejector.

Entries into pool
• Via a standard whirlpool chair that sits outside the tub to allow lower
extremities to be immersed or a whirlpool bench that sits inside a
tank to fully immerse the lower half of the body.

 Adjust the direction and aeration of the turbine
 the entire turbine can be moved from side to side and up and down to
adjust its direction.
 the butterfly valve at the top of the shaft of the turbine adjusts the aeration
of the water.
 the hole at the lower part of the pipe through which air is forced should
always be immersed at least 2 inches below the surface of the water in
order to avoid overheating of the turbine.
 Turn on the turbine.
 Stay with patient throughout the treatment and monitor the patient’s vital
signs before, during, and after treatment as necessary.
 The patient may exercise the affected part during the treatment.
Movement is recommended when treatment is for joint motion or when
edema without acute inflammation is present.
Application

Application
for Upper
Limb
Pic. 1

Whole body application

Advantages
 Weaker muscle can be moved freely than on dry land
(using water properties similar to hydro).
 Allows movement while heat is being applied, unlike
other conductive thermal agents such as hot packs.

Disadvantages
 Size of the tank limits the amount of movements and the size of the
area that may be treated.
 Large quantity of water needed.
 Risk of cross infection.
 Costs associated with cleaning.
 Costs associated with heating water.
 Time consuming - assisting the patient to dress and undress, cleaning
process after each patient.

Safety Precautions
 This recommendation apply for all type of whirlpool.
 The tank should have proper grounded, and the turbine must have
hospital grade plug.
 Should be inspected regularly for any breaks in wiring or insulation
- high risk of severe electrical injury.
 Do not run the turbine without water in the whirlpool because
this can damage the turbine.
 The treatment room should be warm and well ventilated
(ventilation is required to control the humidity of the room & to
remove infectious agents from the air)
 A room temp of 25° to 35°C with relative humidity of 50% is
recommended.

Other precautions
 Increased edema in extremities.
 Cardiac disease.
 Peripheral vascular disease.
 Decreased vital capacity (1.0 L -1.5 L).
 Controlled seizure disorder.

Infection Control
 Generally recommended that only clean water without
any anti-microbacterial to treat open wounds.
 The whirlpool tank and turbines should be properly
drained and cleaned after each used.
 Optimize pt and clinician safety and minimize the risk of
infection.

Cleaning Procedure
• Person cleaning the pool should wear rubber gloves
and goggles throughout the cleaning procedure.
• Drain the tank.
• Rinse the tank with clean water directly from the
hose.
• Scrub the inside of the tank with a brush & detergent
and then rinse the tank again.
• Disinfect the tank- fill the tank with hot water & add
appropriate amount.
• Expose the inside tank to the solution for 10 mins.

• Clean & disinfect the turbine by running it for 5 min in a bucket with
detergent and then for 10 mins in a bucket with disinfectant solution.
• Drain the tank.
• Rinse again with clean water.
• Dry the tank thoroughly with clean towels.
• Wipe all tank hoist cable and seats with disinfectant after
each use.
• Culture samples should be obtained periodically from the tank,
turbines, tank drains and the water supply in accordance with facility
and government guidelines.
Cont..

Contrast Bath

Contrast bath
 Applied by alternately immersing the area to be treated, first in
warm water, then in cool or cold water.
 Generally used for distal extremity treatment.
 This form of hydrotherapy is thought to train the vascular system
by inducing alternating vasodilation and vasoconstriction.
 It is frequently used clinically when the goal of treatment is to
decrease edema.

 Also thought to promote pain relief and for
desensitization.
 May be considered for patient with
 chronic edema; subacute trauma;
 inflammatory conditions such as sprains, strains or
tendonitis;
 hypalgesia or hypersensitivity due to reflex
sympathetic dystrophy.

Contrast bath application
• Preparation of Equipment
 two water containers
 Thermometer
 Towels
 Preparation of Patient
 As per other contact method heat treatment.

• Fill two adjacent containers (whirlpool, buckets or tubs). with
water - one with warm water at 38°C to 44ºC, and the other with
cold or cool water,at 10ºC to 18ºC.
• For pain management or edema control, it is recommended that
the temperature difference between the warm and cold water be
large.
• For desensitization purposes, the temperature difference
between the two baths should be initially small and then
gradually increased as the patient’s sensitivity decreases.
Application

• First, immerse the area to be treated in the warm
water for 3 to 4 minutes; followed by immersion in the
cold water for 1 minute.
• Repeat alternate immersion 5 to 6 times for a total
treatment of 25 min to 35 min.
• End with immersion with warm water.
• Upon completion of treatment, dry the area quickly and
thoroughly.
Cont..

Contrast Bath

Advantages
 May promote a more vigorous circulatory effect than heat or
cold alone.
 Provides good contact with contoured distal extremities compared
to other thermal agents.
 When used properly, is very useful for desensitisation purposes.
 May help to provide pain control without aggravating edema.
 Allow movements in the water for increased circulatory effects.

Disadvantages
 Limb treated is in a dependent position, which may
aggravate edema.
 Some patient do not tolerate cold immersion.
 Lack of research evidence to support the effect of
contrast baths on circulation.

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