The Leisure Review: October 2011

Around 2000 BC the ancient Egyptians first recognised that bathing in warm water brought therapeutic benefits. By about 500 BC the ancient Greeks began to understand the properties and benefits of hydrotherapy. In particular, Hippocrates, the Greek physician, recommended hydrotherapy to assist the relieving of medical conditions such as jaundice and rheumatism. The term hydrotherapy is actually derived from two Greek words, ‘hydro’ meaning water and ‘therapeia’ meaning therapy. As the development of hydrotherapy continued, the Romans enhanced the practice by massaging oils into the skin prior to bathing. The Romans were, of course, also renowned for the fine architecture and sophisticated masonry of their public baths, examples of which can still be seen in the English city of Bath today.

Hydrotherapy is most commonly understood to mean the treatment of illness through the use of water with the objective of ridding the body of toxins that may be inflicting joint pain and inflammation. Water healing is one of the oldest, safest and cheapest methods of treatment and can be used to relieve the symptoms of arthritis, anxiety, back pain, cellulite, muscle weakness, premenstrual syndrome, stress, troubled sleep and fibromyalgia. Hydrotherapy works by using water motion to stimulate the touch receptors on the skin, thus relieving tight muscles and releasing naturally occurring chemicals called endorphins. This also boosts blood circulation and promotes general wellbeing.

There are over ten million people with a limiting long-term illness, impairment or disability in the UK but pool water can also be used by a wider group of people as a preventative method for reducing stress, tension and fatigue and for toning the spinal muscles to reduce the risk of injury. The treatment of a disease or disability using water is complementary to physiotherapy or kinesiotherapy but it is also useful for people with sports injuries and can also benefit people with asthmatic conditions by expanding and exercising the lungs. While spa mineral water therapy is widely accepted in Europe and the Far East, hydrotherapy is more usually practised as a facet of physiotherapy or rehabilitation in the UK.

The specialised hydrotherapy pool is now accepted as an essential aid to recovery for people suffering with arthritis, ME and MS. A hydrotherapy pool can also be used for exercise for physically disabled people or those with learning difficulties and this type of pool is also used for the rehabilitation following injury and illness.

Pools for medical treatment all require specialist water treatment services, highly effective circulation and an above-average water temperature (anything from 30C to 38C). They are usually specifically designed for therapy use and the design should take into account the particular purposes and the range of users. The pool should be accessible for wheelchair users by various methods, such as ramps, hoists, lifts or movable floors, and when planning a hydrotherapy pool facility careful thought must be given to the approach, access, and mobility within the building and to the pool itself. Changing and toilet areas should be designed for specific user groups. There should not be any unnecessary changes of level, restrictions to toilets, cramped changing accommodation or awkward pre-cleanse facilities. This is particularly relevant to the width of the pool surround in connection with the movement of clients in a wheelchair. It is very important that the person responsible for the treatment that clients will receive is consulted at the very start of the design process because they will have an invaluable working knowledge of what is relevant to include. Hydrotherapy pool surface areas and depths will need to be suitable for the users, in some cases with their carers, and the purpose intended.

The environmental control system for a hydrotherapy pool complex needs a great deal of thought especially with regard to appropriate temperatures. The environments of the pool hall, the changing rooms and the toilet area need to be designed for the clients, bearing in mind that in many cases they will not be able to dry themselves. A hydrotherapy pool complex should, if possible, include a cooling-down room so that clients can be acclimatised to the outside temperature or to classrooms or other areas that may follow the treatment.

Depending on the type of user, other features can be added to the hydrotherapy pool to aid the therapeutic treatment, such as underwater sensory coloured lighting, loudspeakers for the transmission of underwater music and water features that can be used for the treatment of strains, sprains and other aches and pains when directed at the affected areas. Many of these additions will also help clients with sight or hearing impairments. Facilities for underwater projected images can be included, a feature that can assist treatment while also making life more enjoyable for respite patients. In the same vein the pool hall ambience can be adjusted using sensory lighting, tiling, projected images and other effects, such as artificial fog and mist.

In addition to hydrotherapy facilities special feature treatment rooms and other types of water therapy can also be included in the design, such as steam rooms, saunas, spa baths, cold plunge pools, ice baths/rooms, decompression chambers, cold or ice rooms and aqua exercise equipment pools. All of these will add to the effectiveness of the complex as a whole.

Deck-level pools for hydrotherapy usage have a number of advantages for disabled bathers and the physiotherapy staff, as they are working at one level, in connection with the water and the pool surround. In-situ, shallow steps with dual hand-railing are helpful to bathers who have some mobility, and will allow them to enter and exit the pool with the minimum of assistance.

It must be remembered that a hydrotherapy pool complex, including any specialist treatment rooms, is in fact a medical facility. Cleanliness and the cleaning regime of the complex must be given a great deal of thought, from the perspective of cleaning and hygiene viewpoint, and of the materials used for the finishes in the pool and on walls, floors and ceilings. It would be wise to consider at the design stage a water-pressure wash-down system to avoid the need for trailing hoses, particularly as the people using the complex will usually have a lower resistance to infection than the general population who might use other pool complexes.

It is also worth pointing out that there are additional facilities that could help particular illnesses and injuries but all of these must be considered at the outset; the first stage of the design process should be to determine how wide the range of users for the facility will be. This will then help to maximise the usage and the revenue and could be an important contributor to the surrounding area’s National Health Service provision.

Jim Gordon is the principal of Jim Gordon Associates. Jim is a member of the SPATA technical committee and he acknowledges previous work undertaken by John Dawes on this important subject.

The Leisure Review series of SPATA articles includes:

Swimming pools: in the tank

Cover stories: a practical guide to getting the right pool cover

Clear thinking: water treatment for pools

Planning your plant room

Finishes for pool tanks and other wet areas

Pool hall switches: environmental control in pool halls and wet areas

The Leisure Review, October 2011

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