Whirlpool Tank

 Whirlpools baths or tanks are stainless-steel tanks, which usually

are utilized for immersion of all or part of the body, use agitated
water to produce convective heat or cooling, massage, and gentle
debridement.
 The force of water agitation is controlled by knobs on the pump or turbine.
Water direction can be controlled by changing the position of the output
nozzle. Temperature may range from 36 to 41 °C. All whirlpools tanks have at
least one turbine and can be stationary or mobile
 Water for the tank can be agitated by turbines, which mix air and
water. The body part is submerged and can be actively moved
during the treatment.

Mechanism of action
1. Water agitation stimulates the skin surface mechanically and thermally. This
stimulation of the large diameter mechanoreceptors and thermoreceptors produce
analgesic effect through the "Gate control mechanism".
2. The mechanical effect of the water irrigation is used for cleaning of open wounds and
removal of débris and necrotic tissues.
3. Mechanical irrigation improves peripheral circulation in cases of ulcers secondary to
poor circulation.
N.B.: Vigorous irrigation can destroy delicate granulation tissues.
o Subcutaneous tissue temperature increases by the water temperature which
results in increasing blood flow.

Types of whirlpool tanks

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 The limb tank is used for immersion of one upper limb, both upper limbs, or
the distal lower limb.
 The lowboy and highboy tanks are used for lower limb immersion or immersion
of the trunk up to the mid thoracic level.
 In the lowboy tank, the patient is in the long sitting position and can perform
ROM exercises with both knees.
 In the highboy tank, the patient is seated in chest-high water with flexed hips and
knees.

Fig. high and low boy whirlpool

Whirlpool Water Temperature

(A) Cold whirlpool:
- 0°Cto26°C (32° F to 79° F).
- Can be used in place of an ice pack or a cold pack, to treat acute
inflammatory conditions of the distal extremities. Low temperatures can
be achieved by adding ice to the whirlpool water; however, very low
temperatures should not be used on large areas due to the increased risk
of tissue damage.

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 (B)Tepid water:
- 26° to 33° C (79° to 92° F).
- Should be used in the whirlpool if the water is being used solely as a
medium for exercise. Warmer temperatures are likely to produce fatigue
and colder temperatures can inhibit muscle contraction
(C) Neutral warmth
- 33° to 35.5° C (92° to 96° F).
- Should be used for the treatment of open wounds and in patients with
circulatory, sensory, or cardiac disorders. Neutral warmth may also be
used to control tone in patients with neurologically based hypertonicity.
(E) Hot whirlpool:
- 37° to 40°C (99° to 104° F).
- Is recommended for the control of pain and/or to increase soft tissue
extensibility because this temperature range of whirlpool water has been
shown to increase the temperature of subcutaneous tissue to within the
range required to produce these effects.
- 40° to 43° C (104°) to
- The higher end of this temperature range is recommended for the
treatment of chronic condition, such as osteoarthritis or rheumatoid arthritis
in the non-acute phases, when small .areas are being treated, while the
lower end of this range is recommended when large areas of the body are
to be immersed.
- The whirlpool temperature should not exceed 43° C (110° F) at any
time because higher temperatures may cause burns.
- The tank should be filled with water immediately before it is used
to prevent the water temperature from changing excessively between
filling and patient immersion. If an antimicrobial is being used, it
should be added to the water as the whirlpool is being filled.
Physiological effects of Whirlpool tank:

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 This tank combines the values of convective heat and gentle massage. The
hydromassage can produce attenuation of pain and muscle spasm. By
a) Producing vasodilatation.
b) Improving local arterial and lymphatic circulation.
c) Breaking down old adhesions after sprains or fractures.
d) Cleansing and stimulating wounds (low temperature used),
e) Mechanical removing of dirties, dead tissue and pus
g) Causing regression of inflammatory processes, and
h) Reduction of edema and effusion.

Indications of whirlpool tank

 Open contaminated wounds. - Contractures

 Burns - Muscle spasms
 degenerative arthritis -Acute musculoskeletal injuries
 Skin ulceration and infection
 Patients who are morbidly obese and immobilized who cannot be
cleaned in another manner after immobilization or casting

Contraindication of whirlpool
1. Diabetes and varicose vein
2. advanced arteriosclerosis.
3. advanced peripheral vascular disease

Practical application of Whirlpool tank

 Select the proper size and /or style of bath according to the size and need of the
patient.

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 The whirlpool; tank is filled with water and check the water temperature by a
thermometer.
 If the bath is made of full stainless steel, the water temperature can be initially
slightly higher than desired as the heat will rapidly radiate through the stainless
steel.
 The water intake holes of the agitator must be well under the water before
starting the motor, as the water intake cools the motor.
 Add disinfectant, to the recommended concentration for mild antiseptic and
for psychological purposes (this addition is optional)
 Adjust the position of patient according to the treated part, ( comfort and
security) and remove all clothing from the part to be treated and as much other
doming as a necessary for comfort and to prevent its saturation with water.
 Place the part in the water.
 In some instances of joint involvement, encourage the patient to move the part
during the treatment, keeping it underwater.
 If treating wounds and patches of dead tissues are removed by the agitated water,
then shut off the agitator occasionally to remove the pieces of tissues from (lie
water to avoid stopping up the agitator).
 Gentle stretching of tight structures and even hand massage may
 be done by the therapist while the limb is under water, f After the
treatment, inspect the part.
 If massage is to be given, keep the part wrapped and wanned until
it can be done.
 Temperature: Water temperature is determined by the amount of the body
submerged, patient health, and goals of treatment. A hand or limited portion of a
limb with intact sensation may tolerate temperatures up to 45 °C. With
immersion to the waist, decrease water temperature to 40-41°C. If most of the
body is submerged, decrease water temperature to 38-39°C.
Duration: 20-45 min.

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 General care before and after each patient may include:
 Empty the tank after use, or be sure proper water recirculation is occurring (ie,
agitator intake and outflow is clear).
 Scrub the inside of tank with a commercial disinfectant. Rinse tub with clean
water. Dry the tank.
 Polish external surface of tank with a commercial stainless steel polish.
 All electrical outlets should have a ground fault circuit interrupter and should be
of the highest industry quality standard available. At no time should a patient or
staff person who is touching or in water be allowed to switch a circuit on or off.
 All electrical outlets should be positioned so that persons being treated are not
easily able to turn the agitator on or off.

Fig. whirlpool application for upper and lower limb

Advantages:

1- It does not occupy a large space.

2- It is suitable for treatment of limbs.

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Disadvantages:

1- Tune and effort consumption.

2 -Edema is induced if the patient does not move the part inside the bath.

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 Hubbard Tank

- It is a large bath used for total boy immersion of an individual patient, and is
usually made of plastic or stainless steel.
- It looks like a figure of 8 or a key hole for practical use allowing the therapist
treatment without having to enter the water.

- The dimensions of the tank are two 240 cm long  180 cm wide  120 cm depth

- Water stretcher and over head carrier may be used to convey non - ambulatory
patient into in and out of the tank.

- It can be transported into hydrotherapy tank in a seated position by using a body

sling and an over head carrier.

- Using one or more turbines for agitation of water. Some of them have a jet hose
to be used for special hydromassge effects or to give under-water douche.

Physiological effects of Hubbard tank:

Same as whirlpool bath and give chance for more exercises for the body.
- Active assisted, resisted and stretching exercises can be done

Indications and Contra - Indications of Hubbard tank:

As whirlpool bath.

Practical application
of Hubbard tank:

 Explain the
procedure of
treatment lo the
patient to prevent the

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 development of fear of water'

 The patient should be dressed in a cotton loin cloth and halter when needed.

- Ear stoppers are not recommended but the ears may be protected by using a
small lamb's wool pad coated with petroleum jelly on the inner side.
- The pad is held in place by the bathing cap.
 The patient is lifted into the tank by means of either a hand
operated hoist or an electrically powered overhead hoist.
 The patient lies on a canvas stretcher which is attached to the hoist by
 cables or he sits in a canvas body sung.
 Lower the patient slowly in water.
 The cables are detached from the sling or stretcher.
 The stretcher is placed on an angle by putting the head End on a stool placed in
the tank for that purpose. This is to raise the patient's head so that it is comfortably
supported outside of the water.
 Apply a cold compress to the patient's head and allow him to lie in the water a
few minutes (adjustment period) before starting the exercises.
 The patient may be given cool drinks to replace water lost in perspiration.
 The tank may by used for immersion baths, but generally some form of
therapeutic exercises is done active - assertive, (active resisted exercises and
stretching shortened muscles)
 The patient should be handled carefully when being removed
form the tank.
 Avoid pressure on the painful areas:
 Free the head end of the submerged plinth and attach the hoist
cables to it.
 Lift the patient and transfer him to a dry plinth.
 Move him quickly and if possible shift the body in one piece.

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 lifting the pelvic area place the hands under buttocks and lift upward.
 Use a draw sheet for heavy patients.
 The patient should be covered to protect the body form air drafts.
 Dry the hair and cover the head with a dry towel and let the patient rest after
the treatment.

Fig. application of hubbard tank in different conditions

Temperature . 3 6 - 41 °C

Lower temperature : used for muscle re-education or active exercises.

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Higher temperature: used for cerebral palsy children, relaxation of muscle,
sedation, stretching soft tissues. The temperature of the water and the pressure of
the whirling water are easily controlled.

Duration: 15 -30 min.

Precautions:

I- The patient should not be left alone when he is in the Hubbard tank.

There is a danger of accidental drowning with some patients who are too
severely disabled to protect themselves.
II- The following measures should be taken into consideration to prevent
cross- infection:
a- Patients with communicable diseases as skin rashes or cold are either not
allowed into the tank or are put into the tank alone.
b- Only well children or poliomyelitis patients in the subacute stage are placed
together in the tank.
c- Use clean water for each patient or each group of patients.

Advantages of Hubbard tank:

1- Tanks are cheaper to install and maintain than other therapeutic pools'
2- The therapist does not have to enter the tank to give the
treatment.
3- The tank requires a small amount of space.

Disadvantages:
1- Tanks do not have the buoyancy of a pool because of the small volume of
water.
2- The number of exercises are limited by the depth and size of me tank.
3- The therapist can not get as close to the patient as in a pool.

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