Although hydrotherapy is very effective in physiotherapy rehabilitation, Charles Munyambonera, a physical therapist in Kigali, says it is not used as much within. He says that this form of treatment is very effective, especially for people with rheumatic ailments. “This is because when this form of treatment is used, such patients have chances to do their movement with less pain, and as they do so, their joints get the movements they might have lost before,” he says. The medic goes on to warn that this form of treatment should only be carried out by skilled personnel to avoid risks and repercussions. He, however, encourages hospitals to include this form of treatment in the physiotherapy modalities. At the moment, the only known health facility with skilled personnel that offers hydrotherapy treatment in the country is King Faisal Hospital. Understanding hydrotherapy Francis Habumugisha Goodrich, PhD Public health practitioner in Kigali, says hydrotherapy or water cure is a part of alternative medicine, occupational therapy, and physiotherapy that involves the use of water for pain relief and treatment. He says that it involves the use of water to treat conditions, such as arthritis, rheumatic complaints and other ailments. Although it bears a resemblance to swimming, he says it is different because it requires the individual to undertake various exercises in a warm pool of water. The water temperature in the pool, he says, should approximately be 33 to 36ºC. “This water is much warmer than what you will encounter in a normal swimming pool. Hydrotherapy treatment is usually conducted in a hospital’s physiotherapy department,” he says. Why it’s important Munyambonera says hydrotherapy uses the principle known as Archimedes. He explains that this is when you put something in the water; it tends to go vertically with animation of gravity. “The power to come up is equal to the water that is moving it. This scientific principle is the one helping in treating people,” he says. Munyambonera says when treating patients with limited range of motion, limited movements in the joints, they can easily do movements underwater than when they are not. But again, he notes that when one wants to apply resistance, like going downwards from the upper part, it becomes hard. Conditions where hydrotherapy is applicable According to Munyambonera, hydrotherapy is good for people with pain, or those who feel pain when they are doing movements, and if they use water, the pain lessens. It is also used with people who have rheumatic conditions like arthritis, polyarthritis, as this helps them do their movements with less pain. This, he says, doesn’t mean that the pain will go down to zero, but at least it won’t be as intense. Hydrotherapy is also used for people who had surgeries, such as post joint surgeries, as they tend to have pain after surgery. “For them to go back to the normal movements of their body and restore them, they start with less painful procedures that can be done underwater,” he says. It’s also applicable in post hip surgeries — this is where the joint of the hip has been replaced by a metal. In such cases, he says they expect the patient to have limited movements in the hip. Back surgeries and gout are also some of the conditions where hydrotherapy can be applicable. Habumugisha says gout’s complications can sometimes spread to other places, like the knees. “For such people, they hardly do their movements, have bent knees and because this condition is so painful, it’s not possible to bring back their range in the normal setting, therefore hydrotherapy becomes the only option,” he says. He adds that any movement they do actively or perceivably may lead to a lot of pain. In such cases, he says what is normally done is to put them under hot water as the hot water tends to relax the muscles. What you should know Munyambonera says after the patients do active exercises themselves, the muscles and joints become relaxed. Another important aspect, he says, is that patients, when under water, need to be helped to stretch and mobilise stiff joints. He goes on to add that an expert can include resistance, like using heavy balls underwater. “The balls tend to help bring them back, push them into the water, and this becomes resistance,” he says. For instance, he mentions that in the case where a patient has a weak leg, they push them back downwards, where the water acts as resistance. With pain, limited range of motion can be used in muscle weakness, and arthritis conditions. Celestine Karangwa, a physiotherapist at TCM Technology Clinic in Remera, Kigali, says in medicine, a contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment due to the harm that it would cause the patient. “Contraindication is the opposite of indication, which is a reason to use a certain treatment, he says. Munyambonera says there are contradictions where hydrotherapy isn’t inducted. For instance, he says, if a person has a fresh and open wound, hydrotherapy is contraindicated because it may lead to infection. “Even though it has to be cleaned with disinfectants before and after use, even the patient might re-infect themselves from the skin to the wound,” he cautions. Also, when treating people with urinary incontinence, hydrotherapy is contraindicated as well. He says that when they go in hydrotherapy, controlling the urine could be hard for them. How long does treatment take? Depending on the amount of pain, Habumugisha says with hydrotherapy, the time it takes for one to be completely healed varies. For example, he points out that people with rheumatic pains can’t be relieved in a day. Therefore, he says, as they have more sessions, they get to feel better with time. He says that normally, one session can go for 30 minutes to an hour. Munyambonera explains that this is because when people are doing exercises in hot water, generally, they get tired within a short time. Some can do an hour or 40 minutes per session, so they always consider the patient’s condition. Generally, he says, they consider 15 sessions as a starting point for many conditions, but those with paralysis might need many more sessions because of their condition.
