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