Methods in Aquatic Therapy or Hydrotherapy - EWAC Medical

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


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


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
Pure lateral flexion X X X X
Flexion – lateral flexion – rotation X X X X
Extension – Lateral flexion- rotation X X X X
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.

Hydrotherapy equipment


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