The Effect of The Therapeutic Whirlpool On The Viscoelastic Properties of The Skin
Year 2024,
Volume: 2 Issue: 1, 21 - 28, 24.06.2024
Tüzün Fırat
,
Semin Akel
,
Çiğdem Öksüz
Abstract
Changes in the skin function after whirlpool application have not previously been investigated. The aim of the study was to investigate the effects of the therapeutic whirlpool on the biophysical properties of the skin in healthy individuals.
24 healthy individuals (12 women, 12 men) received therapeutic whirlpool for 20 minutes, 5 days per week in every day and 48 hands were evaluated in this prospective cohort study. Skin elasticity, moisture, transepidermal water loss (TEWL), pH and temperature were measured before the first session, after the first session and after the fifth session. The measurements were taken from the palmar and dorsal side of the hand.
On the volar side, the elasticity and the temperature did not change after treatment (p=0.054 and p=0.100). TEWL and pH increased while the moisture decreased after the first session (p<0.016). The pH was also high after the last session (p<0.001). On the dorsal side, the moisture did nod change (p=0.105). TEWL increased after first session and decreased after last session (p<0.016). The pH increased soon after the first session and after the 5th session (p<0.016). The elasticity decreased after the first session (p<0.016). Lastly, the temperature was found to decrease between 2nd and 3rd measurements (p=0.033).
According to our results, whirlpool leads the loss of the skin barrier function in healthy individuals and the skin should be protected soon after therapeutic whirlpool. Electrophysical agent applications such as electrical stimulation to be applied after whirlpool should be planned carefully.
Supporting Institution
None.
Thanks
The authors sincerely and respectfully thank the volunteer individuals who participated in the study.
References
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- 2. Hayes KW. Hydrotherapy. Manual for physical agents. 5 ed. New Jersey: Prentice-Hall; 2000. p. 21-30.
- 3. Xu F, Wen T, Lu TJ, Seffen KA. Skin biothermomechanics for medical treatments. J Mech Behav Biomed Mater. 2008;1(2):172-87.
- 4. Szekeres M, MacDermid JC, Birmingham T, Grewal R, Lalone E. The Effect of Therapeutic Whirlpool and Hot Packs on Hand Volume During Rehabilitation After Distal Radius Fracture: A Blinded Randomized Controlled Trial. Hand (N Y). 2017;12(3):265-71.
- 5. Nadler SF, Weingand K, Kruse RJ. The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain Physician. 2004;7(3):395-9.
- 6. Tao H BJ, Luttrell T. The Role of Whirlpool in Wound Care. Journal of the American College of Clinical Wound Specialists 2013;4:7-12.
- 7. Igaki M, Higashi T, Hamamoto S, Kodama S, Naito S, Tokuhara S. A study of the behavior and mechanism of thermal conduction in the skin under moist and dry heat conditions. Skin research and technology : official journal of International Society for Bioengineering and the Skin. 2014;20(1):43-9.
- 8. Petrofsky JS, Bains G, Raju C, Lohman E, Berk L, Prowse M, et al. The effect of the moisture content of a local heat source on the blood flow response of the skin. Archives of dermatological research. 2009;301(8):581-5.
- 9. Petrofsky J, Gunda S, Raju C, Bains GS, Bogseth MC, Focil N, et al. Impact of hydrotherapy on skin blood flow: How much is due to moisture and how much is due to heat? Physiother Theory Pract. 2010;26(2):107-12.
- 10. Nishimura N, Inoue S, Yokoyama K, Iwase S. Effect of spraying of fine water particles on facial skin moisture and viscoelasticity in adult women. Skin Res Technol. 2019;25(3):294-8.
- 11. Baker P, Huang C, Radi R, Moll SB, Jules E, Arbiser JL. Skin Barrier Function: The Interplay of Physical, Chemical, and Immunologic Properties. Cells. 2023;12(23).
- 12. Treffel P, Panisset F, Faivre B, Agache P. Hydration, transepidermal water loss, pH and skin surface parameters: correlations and variations between dominant and non-dominant forearms. Br J Dermatol. 1994;130(3):325-8.
- 13. Cua AB, Wilhelm KP, Maibach HI. Elastic properties of human skin: relation to age, sex, and anatomical region. Archives of dermatological research. 1990;282(5):283-8.
- 14. Heylings JR, Diot S, Esdaile DJ, Fasano WJ, Manning LA, Owen HM. A prevalidation study on the in vitro skin irritation function test (SIFT) for prediction of acute skin irritation in vivo: results and evaluation of ECVAM Phase III. Toxicol In Vitro. 2003;17(2):123-38.
- 15. Mündlein M, Valentin B, Chabicovsky R, Nicolics J, Weremczuk J, Tarapata G, et al. Comparison of transepidermal water loss (TEWL) measurements with two novel sensors based on different sensing principles. Sensors and Actuators A: Physical. 2008;142(1):67-72.
- 16. Schmid-Wendtner MH, Korting H. The pH of the skin surface and its impact on the barrier function. Skin pharmacology and physiology. 2006;19(6):296-302.
- 17. Juve Meeker B. Whirlpool therapy on postoperative pain and surgical wound healing: an exploration. Patient Educ Couns. 1998;33(1):39-48.
- 18. Cornelius WL, Hands MR. The effects of a warm-up on acute hip joint flexibility using a modified PNF stretching technique. Journal of athletic training. 1992;27(2):112.
- 19. Kuligowski LA, Lephart SM, Giannantonio FP, Blanc RO. Effect of whirlpool therapy on the signs and symptoms of delayed-onset muscle soreness. J Athl Train. 1998;33(3):222-8.
- 20. Yalçın G, Mülkoğlu C, Gülmez S, Genç H. The effect of mirror therapy in the rehabilitation of flexor tendon injuries after primary surgical repair. Hand Surg Rehabil. 2024;43(1):101612.
- 21. Szekeres M, MacDermid JC, Grewal R, Birmingham T. The short-term effects of hot packs vs therapeutic whirlpool on active wrist range of motion for patients with distal radius fracture: A randomized controlled trial. J Hand Ther. 2018;31(3):276-81.
- 22. Horváth J, Bálint Z, Szép E, Deiszinger A, Minier T, Farkas N, et al. Efficacy of intensive hand physical therapy in patients with systemic sclerosis. Clin Exp Rheumatol. 2017;35 Suppl 106(4):159-66.
- 23. Lim KO, Lee DY, Shin WS. The effects of a warm whirlpool bath on pain and stiffness of patients with chronic stroke induced knee osteoarthritis. J Phys Ther Sci. 2013;25(7):873-5.
- 24. Moore Z, Cowman S. A systematic review of wound cleansing for pressure ulcers. J Clin Nurs. 2008;17(15):1963-72.
- 25. Nam GW, Baek JH, Koh JS, Hwang JK. The seasonal variation in skin hydration, sebum, scaliness, brightness and elasticity in Korean females. Skin research and technology : official journal of International Society for Bioengineering and the Skin. 2015;21(1):1-8.
- 26. Woo MS, Moon KJ, Jung HY, Park SR, Moon TK, Kim NS, et al. Comparison of skin elasticity test results from the Ballistometer((R)) and Cutometer((R)). Skin research and technology : official journal of International Society for Bioengineering and the Skin. 2014;20(4):422-8.
- 27. Sandford E, Chen Y, Hunter I, Hillebrand G, Jones L. Capturing skin properties from dynamic mechanical analyses. Skin research and technology : official journal of International Society for Bioengineering and the Skin. 2013;19(1):e339-48.
- 28. Algiert-Zielinska B, Batory M, Skubalski J, Rotsztejn H. Evaluation of the relation between lipid coat, transepidermal water loss, and skin pH. Int J Dermatol. 2017;56(11):1192-7.
- 29. Ye C, Chen J, Yang S, Yi J, Chen H, Li M, et al. Skin sensitivity evaluation: What could impact the assessment results? J Cosmet Dermatol. 2019.
- 30. Yazdanparast T, Yazdani K, Humbert P, Khatami A, Ahmad Nasrollahi S, Hassanzadeh H, et al. Comparison of biophysical, biomechanical and ultrasonographic properties of skin in chronic dermatitis, psoriasis and lichen planus. Med J Islam Repub Iran. 2018;32:108.
- 31. Firat T, Ayhan C, Iscan YY, Kirdi N, Leblebicioglu G. Measurement of Transepidermal Water Loss and Skin Moisture in Peripheral Nerve Lesions: A Pilot Study. Journal of Hand Therapy. 2010;23(4):e9-e10.
- 32. Kang MJ, Kim BS, Hwang S, Yoo HH. Experimentally derived viscoelastic properties of human skin and muscle in vitro. Med Eng Phys. 2018;61:25-31.
- 33. Sar Z, Polat MG, Ozgul B, Aydogdu O, Camcoglu B, Acar AH, et al. A comparison of three different physiotherapy modalities used in the physiotherapy of burns. J Burn Care Res. 2013;34(5):e290-6.
- 34. Walsh M. Hydrotherapy: The use of water as a therapeutic agent. In: SL M, editor. Thermal agents in rehabilitation. Philadelphia: FA Davis; 1986. p. 119-40.
- 35. Lim KO LD, Shin WS. The effects of a warm whirlpool bath on pain and stiffness of patients with chronic stroke induced knee osteoarthritis. J Phys Ther Sci. 2013 25(7):873-5.
- 36. Kuligowski LA, Lephart SM, Giannantonio FP, Blanc RO. Effect of whirlpool therapy on the signs and symptoms of delayed-onset muscle soreness. Journal of athletic training. 1998;33(3):222.
- 37. Heathcote SL, Hassmen P, Zhou S, Taylor L, Stevens CJ. How Does a Delay Between Temperate Running Exercise and Hot-Water Immersion Alter the Acute Thermoregulatory Response and Heat-Load? Front Physiol. 2019;10:1381.
- 38. Yosipovitch G, Hu J. Clinical Features-Free CME-The Importance of Skin pH-Here's what you need to educate patients about regarding skin pH, so that they can protect themselves. Skin and Aging-Journal of Geriatric Dermatology. 2003;11(3):88-94.
- 39. Panisset F, Treffel P, Faivre B, Lecomte P, Agache P. Transepidermal water loss related to volar forearm sites in humans. Acta dermato-venereologica. 1991;72(1):4-5.
- 40. Proksch E. pH in nature, humans and skin. J Dermatol. 2018;45(9):1044-52.
- 41. Parra J, Paye M. EEMCO guidance for the in vivo assessment of skin surface pH. Skin pharmacology and applied skin physiology. 2002;16(3):188-202.
Year 2024,
Volume: 2 Issue: 1, 21 - 28, 24.06.2024
Tüzün Fırat
,
Semin Akel
,
Çiğdem Öksüz
References
- 1. Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015;127(1):57-65.
- 2. Hayes KW. Hydrotherapy. Manual for physical agents. 5 ed. New Jersey: Prentice-Hall; 2000. p. 21-30.
- 3. Xu F, Wen T, Lu TJ, Seffen KA. Skin biothermomechanics for medical treatments. J Mech Behav Biomed Mater. 2008;1(2):172-87.
- 4. Szekeres M, MacDermid JC, Birmingham T, Grewal R, Lalone E. The Effect of Therapeutic Whirlpool and Hot Packs on Hand Volume During Rehabilitation After Distal Radius Fracture: A Blinded Randomized Controlled Trial. Hand (N Y). 2017;12(3):265-71.
- 5. Nadler SF, Weingand K, Kruse RJ. The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain Physician. 2004;7(3):395-9.
- 6. Tao H BJ, Luttrell T. The Role of Whirlpool in Wound Care. Journal of the American College of Clinical Wound Specialists 2013;4:7-12.
- 7. Igaki M, Higashi T, Hamamoto S, Kodama S, Naito S, Tokuhara S. A study of the behavior and mechanism of thermal conduction in the skin under moist and dry heat conditions. Skin research and technology : official journal of International Society for Bioengineering and the Skin. 2014;20(1):43-9.
- 8. Petrofsky JS, Bains G, Raju C, Lohman E, Berk L, Prowse M, et al. The effect of the moisture content of a local heat source on the blood flow response of the skin. Archives of dermatological research. 2009;301(8):581-5.
- 9. Petrofsky J, Gunda S, Raju C, Bains GS, Bogseth MC, Focil N, et al. Impact of hydrotherapy on skin blood flow: How much is due to moisture and how much is due to heat? Physiother Theory Pract. 2010;26(2):107-12.
- 10. Nishimura N, Inoue S, Yokoyama K, Iwase S. Effect of spraying of fine water particles on facial skin moisture and viscoelasticity in adult women. Skin Res Technol. 2019;25(3):294-8.
- 11. Baker P, Huang C, Radi R, Moll SB, Jules E, Arbiser JL. Skin Barrier Function: The Interplay of Physical, Chemical, and Immunologic Properties. Cells. 2023;12(23).
- 12. Treffel P, Panisset F, Faivre B, Agache P. Hydration, transepidermal water loss, pH and skin surface parameters: correlations and variations between dominant and non-dominant forearms. Br J Dermatol. 1994;130(3):325-8.
- 13. Cua AB, Wilhelm KP, Maibach HI. Elastic properties of human skin: relation to age, sex, and anatomical region. Archives of dermatological research. 1990;282(5):283-8.
- 14. Heylings JR, Diot S, Esdaile DJ, Fasano WJ, Manning LA, Owen HM. A prevalidation study on the in vitro skin irritation function test (SIFT) for prediction of acute skin irritation in vivo: results and evaluation of ECVAM Phase III. Toxicol In Vitro. 2003;17(2):123-38.
- 15. Mündlein M, Valentin B, Chabicovsky R, Nicolics J, Weremczuk J, Tarapata G, et al. Comparison of transepidermal water loss (TEWL) measurements with two novel sensors based on different sensing principles. Sensors and Actuators A: Physical. 2008;142(1):67-72.
- 16. Schmid-Wendtner MH, Korting H. The pH of the skin surface and its impact on the barrier function. Skin pharmacology and physiology. 2006;19(6):296-302.
- 17. Juve Meeker B. Whirlpool therapy on postoperative pain and surgical wound healing: an exploration. Patient Educ Couns. 1998;33(1):39-48.
- 18. Cornelius WL, Hands MR. The effects of a warm-up on acute hip joint flexibility using a modified PNF stretching technique. Journal of athletic training. 1992;27(2):112.
- 19. Kuligowski LA, Lephart SM, Giannantonio FP, Blanc RO. Effect of whirlpool therapy on the signs and symptoms of delayed-onset muscle soreness. J Athl Train. 1998;33(3):222-8.
- 20. Yalçın G, Mülkoğlu C, Gülmez S, Genç H. The effect of mirror therapy in the rehabilitation of flexor tendon injuries after primary surgical repair. Hand Surg Rehabil. 2024;43(1):101612.
- 21. Szekeres M, MacDermid JC, Grewal R, Birmingham T. The short-term effects of hot packs vs therapeutic whirlpool on active wrist range of motion for patients with distal radius fracture: A randomized controlled trial. J Hand Ther. 2018;31(3):276-81.
- 22. Horváth J, Bálint Z, Szép E, Deiszinger A, Minier T, Farkas N, et al. Efficacy of intensive hand physical therapy in patients with systemic sclerosis. Clin Exp Rheumatol. 2017;35 Suppl 106(4):159-66.
- 23. Lim KO, Lee DY, Shin WS. The effects of a warm whirlpool bath on pain and stiffness of patients with chronic stroke induced knee osteoarthritis. J Phys Ther Sci. 2013;25(7):873-5.
- 24. Moore Z, Cowman S. A systematic review of wound cleansing for pressure ulcers. J Clin Nurs. 2008;17(15):1963-72.
- 25. Nam GW, Baek JH, Koh JS, Hwang JK. The seasonal variation in skin hydration, sebum, scaliness, brightness and elasticity in Korean females. Skin research and technology : official journal of International Society for Bioengineering and the Skin. 2015;21(1):1-8.
- 26. Woo MS, Moon KJ, Jung HY, Park SR, Moon TK, Kim NS, et al. Comparison of skin elasticity test results from the Ballistometer((R)) and Cutometer((R)). Skin research and technology : official journal of International Society for Bioengineering and the Skin. 2014;20(4):422-8.
- 27. Sandford E, Chen Y, Hunter I, Hillebrand G, Jones L. Capturing skin properties from dynamic mechanical analyses. Skin research and technology : official journal of International Society for Bioengineering and the Skin. 2013;19(1):e339-48.
- 28. Algiert-Zielinska B, Batory M, Skubalski J, Rotsztejn H. Evaluation of the relation between lipid coat, transepidermal water loss, and skin pH. Int J Dermatol. 2017;56(11):1192-7.
- 29. Ye C, Chen J, Yang S, Yi J, Chen H, Li M, et al. Skin sensitivity evaluation: What could impact the assessment results? J Cosmet Dermatol. 2019.
- 30. Yazdanparast T, Yazdani K, Humbert P, Khatami A, Ahmad Nasrollahi S, Hassanzadeh H, et al. Comparison of biophysical, biomechanical and ultrasonographic properties of skin in chronic dermatitis, psoriasis and lichen planus. Med J Islam Repub Iran. 2018;32:108.
- 31. Firat T, Ayhan C, Iscan YY, Kirdi N, Leblebicioglu G. Measurement of Transepidermal Water Loss and Skin Moisture in Peripheral Nerve Lesions: A Pilot Study. Journal of Hand Therapy. 2010;23(4):e9-e10.
- 32. Kang MJ, Kim BS, Hwang S, Yoo HH. Experimentally derived viscoelastic properties of human skin and muscle in vitro. Med Eng Phys. 2018;61:25-31.
- 33. Sar Z, Polat MG, Ozgul B, Aydogdu O, Camcoglu B, Acar AH, et al. A comparison of three different physiotherapy modalities used in the physiotherapy of burns. J Burn Care Res. 2013;34(5):e290-6.
- 34. Walsh M. Hydrotherapy: The use of water as a therapeutic agent. In: SL M, editor. Thermal agents in rehabilitation. Philadelphia: FA Davis; 1986. p. 119-40.
- 35. Lim KO LD, Shin WS. The effects of a warm whirlpool bath on pain and stiffness of patients with chronic stroke induced knee osteoarthritis. J Phys Ther Sci. 2013 25(7):873-5.
- 36. Kuligowski LA, Lephart SM, Giannantonio FP, Blanc RO. Effect of whirlpool therapy on the signs and symptoms of delayed-onset muscle soreness. Journal of athletic training. 1998;33(3):222.
- 37. Heathcote SL, Hassmen P, Zhou S, Taylor L, Stevens CJ. How Does a Delay Between Temperate Running Exercise and Hot-Water Immersion Alter the Acute Thermoregulatory Response and Heat-Load? Front Physiol. 2019;10:1381.
- 38. Yosipovitch G, Hu J. Clinical Features-Free CME-The Importance of Skin pH-Here's what you need to educate patients about regarding skin pH, so that they can protect themselves. Skin and Aging-Journal of Geriatric Dermatology. 2003;11(3):88-94.
- 39. Panisset F, Treffel P, Faivre B, Lecomte P, Agache P. Transepidermal water loss related to volar forearm sites in humans. Acta dermato-venereologica. 1991;72(1):4-5.
- 40. Proksch E. pH in nature, humans and skin. J Dermatol. 2018;45(9):1044-52.
- 41. Parra J, Paye M. EEMCO guidance for the in vivo assessment of skin surface pH. Skin pharmacology and applied skin physiology. 2002;16(3):188-202.