As the body moves forward through the water a pressure wave builds up in front and, the faster the pace, the more effort is needed to overcome it. With EDS/HMS patients walking fast, using short precise steps is preferable, avoiding hyperextension at hip or knee. Emphasis should be placed on controlling the legs and not allowing "Wobble" at the hip of either the moving or standing leg. Tile lines are useful here, as the patient can concentrate on moving straight down the line, and not allowing any deviation to either side. As strengh and balance improve, speed can be increased and the hydropherapist can add turbulance, while encouraging the keeping of a straight course against the uneven flow of water.
Brisk sideways walking works hip abductors and adductors. Here the point to watch is that the patients pelvis and toes face sqaure on to the wall, so there is true abduction and adduction, not flexion, taking place at the hips. Small range, moving fast works best, and the ankle of the moving leg is everted as the leg is pushed out, inverted as it pulls in, to prevent passive overstraining of the ankles by flow of the water.
Hip flexors and extensors
A) Isometric. Standing chest deep in water, holding rail for balance. Swing one leg briskly backwards and forwards, in a small range, keeping the knee straight, but not hyperextended. Make sure there is no "wobble" on standing or moving the leg.
B) Static. Lying. fully supported, on bed, small ring around thigh. push down against resistance of float, hold for count of 10, and relax. To increase the work use a larger ring around thigh,a s moving the ring to the ankle to lengthen the lever, as would be usual will force the knee into hyperextension.
Knee flexors and extensors
A) Isometric. Standing chest deep in water, holding rail. Flex and extend one knee briskly, avoiding hypermobile range.
B) Static. Quads:-
Standing facing the wall, inclined at an angle of 45Ã‚Âº, with float around ankle, and knee bent (Avoid forcible flexion of knee by float) Extend knee against float, hold for counts of 10, relax.
Sitting with one knee extended, and float around ankle (Again avoid forcible extension of knee by float) Bend knee against resistance of float, hold for count of 10, relax.
With the patient sitting up to her neck in the water, shoulder flexors and extensors, ab and adductors, elbows and wrists can be worked in the same way, using small range free exercises pushing strongly through the water, followed by static holds against the buoyancy of a float. Shoulder rotators can be worked with the patient sitting, elbows bent to 90Ã‚Âº, and held into the waist, while the hands move in and out. Towards and away from the midline. As the shoulders become more stable it may be possible to use plastic hand paddles to increase the resistance. The ones with wide straps over wrists and hands are preferable, as they support the wrists in the flow of the water.
Cool down period
Many EDS/HMS patients have hypermobile cervical vertebrae, and are unhappy about using a head collar to float as it strains the neck. Always check this, but if they are comfortable in a collar, or confident enough t float without one, effective stabilising exercises can be done in floating. For example, with the patient supine in floats arms abducted, grasping paddles the physiotherapist fixes the hips, and pulls the patient backwards and forwards through the water. While the arm position does not alter. This technique can be adapted to other parts of the body, where the patient hold the join in a fixed position against the turbulence and drag created by the hydrotherapist.
Rhythmic stabilisations can also be performed, using annual resistance, in sitting and standing. The cool-down period could include balance work, such as slow walking, standing on one leg, and slow stepping up and down on small step, with the emphasis on control of the movement and balance. These exercises can be made more difficult by the physiotherapist adding turbulence