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Bad Ragaz Ring Method

Bad Ragaz Ring is a method which utilizes flotation rings at the neck, pelvis, knees and or ankles, to support the patient in an horizontal supine position. this method is a strengthening and mobilizing resistive exercise model, which uses 33 degrees Celsius water. the force used by the patient should be less than therapist force. it should be used in the early rehabilitative stage of patient care.

Bad ragaz ring should be combined with other methods which focuses on increasing activities and participation, an example is Water specific therapy (halliwick method).

Advantages which the hydrotherapy method provides

re-education utilizing specific patterns of resistance
endurance
expansion of the spine
relaxation
range of motion
tone reduction
trunk alignment
stability

Application

Patients with the following symptoms or disability’s benefit from Bad Ragaz Ring method:

Pain with movement
decreased range of motion
spasticity
decreased coordination
proprioceptive or sensory deficits
weakness or low tone
restricted weight bearing

This technique can be used for the following:

Peripheral joint problems like osteoarthritis
Inflammatory diseases like rheumatoid arthritis or ankylosing spondylitis
Chronic spine problems
General weakness or motor control deficit from neurological diseases like stroke, peripheral nerve lesions, polyneuropathies
Impairments post-surgery, like trauma and joint replacement

Method

The therapist can be located at the patients head, side’s or feet to perform movement such as rolling. the ideal position for the therapist is between thoracic vertebra 8 to thoracic vertebra 11 of the thoracic spine. the therapist uses aquatic principles to interact with the patient. these interaction (exercises) are Passive to isometric, isokinetic and isotonic.

Indication of BRRM and relationship to ICF

Increasing	ICF body Function	Decreasing	ICF Body Function
Stength	Muscle power functions	muscular tone	Muscle tone functions
Joint stability	Involuntary movement reaction functions	Pain	Sensation of pain
Joint stability	Stability of joint functions
Range of motion	Mobility of joint functions
Local muscle endurance	Muscle endurance functions
Preparing lower extremities for weight-bearing	Gait pattern functions

Applications of the treatment technique from PNF (Proprioceptive Neuromuscular Facilitation) used in BRRM.

Treatment Techniques
Rhythmic Initiation	The therapist starts with the pattern passively and then asks the patient for more and more help. at the end the patient performs the pattern on his/her own.
Reversal of antagonists	change from one pattern to the opposite pattern without a break.
Repeaeted contractions or stretch	Repeated stretch through the range, resist the pattern and stretch the active muscles and ask for increased contraction.
Combination of isotonic	In the desired movement combine isotonic concentric work with isometric and isotonic eccentric work. there is no relaxation between the different types of muscle.
Timing for emphasis	Change the normal timing of the movement to applied timing in other joints. stabilize the strong joints and move the weak one.
Hold relax	bring the body in the desired position and increase slowly the resistance without any movement. Ask for hold the position.
Contract relax	Bring the body in the desired position and ask to pull the body in a desired direction. Resist the movement.

Patterns	Rhymthmic Initiation	Reversal of Antagonists	Combination of Isotonic	Repeated Contraction	Hold relax	Contract-relax	Timing for Emphasis
Trunk
Pure lateral flexion	X	X	X		X
Flexion – lateral flexion – rotation	X	X	X		X
Extension – Lateral flexion- rotation	X	X	X		X

ARM
Flexion – abduction – external rotation	X	X	X	X	X	X	X
Extension – Adduction – internal rotation	X	X	X	X	X	X	X

Leg bilateral symmetrical
Flexion – adduction – External rotation	X	X
Extension – abduction – internal rotation	X	X
Flexion – abduction – internal rotation	X	X
Extension – adduction – external rotation	X	X

Leg bilateral Reciprocal knee Flexion
Flexion – Adduction – external rotation (isotonic) – extension – adduction – external rotation (isometric)	X		X	X	X	X	X
Flexion – Abduction – internal rotation (isotonic) – extension – abduction – internal rotation (isometric)	X		X	X	X	X	X
Extension – Adduction – external rotation (isotonic) – flexion – adduction – external rotation (isometric)	X		X	X	X	X	X
Extension – Abduction – internal rotation (isotonic) – flexion – abduction – internal rotation (isometric)	X		X	X	X	X	X

Leg Bilateral Reciprocal Knee Extension
Flexion – abduction – internal rotation (isotonic) – Extension – abduction – internal rotation (isotonic)	X	X
Extension – adduction – external rotation (isotonic) – Flexion – adduction – external rotation (isotonic)	X	X

watch out with patients who have frequent ear infections. it’s important to monitor the patients breathing.

Sources

The bad Ragaz Ring Method, Urs N. Gamper and Johan Lambeck (2010) An introduction to Aquatic Therapy, Kirk Howard (2016)

Articles

Hajouj (2020) Effects of Innovative Aquatic Proprioceptive Training on Knee Proprioception in Athletes with Anterior Cruciate Ligament Reconstruction A Randomized Controlled Trial

The Bad Ragaz Ring Method (Gamper & Lambeck 2010)

Methajarunon (2016) Systematic review of published studies on aquatic exercise for balance in patients with multiple sclerosis, Parkinson’s disease, and hemiplegia.

Becker & Lynch (2018) Case Report Aquatic Therapy and End-Stage Dementia

Epps (2005) Is hydrotherapy cost-effective, A randomised controlled trial of combined hydrotherapy programmes

Slides

Rehabilitation concepts using hydrotherapy

The importance of the right depth

Lambeck (2009) How to use the Bad Ragaz Ring Method to treat function impairments of the lower extremities