Background: WaterShiatsu (WATSU) is a passive form of hydrotherapy in warm water (35 °C) that aims at relaxation, pain relief, and a sense of security. This case report focuses on a patient's experience of integrating WATSU into her rehabilitative care. Case Report: A 52-year-old woman survived a severe motorcycle accident in which she sustained several fractures on the right side of her body, including ribs, the pelvis, and the femur. After discharge from stationary care, she independently scheduled 8 weekly WATSU sessions with an experienced WATSU therapist also trained in physiotherapy and psychosomatics. Quantitative and qualitative data obtained from the patient's diary and the therapist's notes is presented. Results: The patient associated WATSU with physical and emotional release, reconciliation with her body, and trunk mobilization (followed by ameliorated breath). She ascribed WATSU lasting effects on her body image and reported continuous improvement by the Patient-Specific Functional Scale. The therapist employed WATSU to equalize awareness throughout the body and for careful mobilization. Due to complications (elevated inflammation markers), only 6 of 8 scheduled sessions were administered. Conclusions: WATSU was experienced as helpful in approaching a condition that the patient felt insufficiently covered by conventional physiotherapy alone. In early rehabilitation, additional medical/physiotherapeutic skills of contributing complementary therapists are advocated.

1.
Eardley S, Bishop FL, Prescott P, Cardini F, Brinkhaus B, Santos-Rey K, Vas J, von Ammon K, Hegyi G, Dragan S, Uehleke B, Fonnebo V, Lewith G: A systematic literature review of complementary and alternative medicine prevalence in EU. Forsch Komplementmed 2012;19(suppl 2):18-28.
2.
Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL: Trends in the use of complementary health approaches among adults: United States, 2002-2012. Natl Health Stat Report 2015;79:1-16.
3.
Murthy V, Sibbritt D, Adams J: An integrative review of complementary and alternative medicine use for back pain: a focus on prevalence, reasons for use, influential factors, self-perceived effectiveness and communication. Spine J 2015;15:1870-1883.
4.
Adams J, Andrews G, Barnes J, Broom A, Magin P: Traditional, Complementary and Integrative Medicine: An International Reader. Basingstoke, Palgrave Macmillan, 2012.
5.
Schitter AM, Nedeljkovic M, Baur H, Fleckenstein J, Raio L: Effects of passive hydrotherapy WATSU (WaterShiatsu) in the third trimester of pregnancy: results of a controlled pilot study. Evid Based Complement Alternat Med 2015;2015:437650.
6.
Zimmermann F: Mindfulness-based practices as a resource for health and well-being. Med Acupunct 2015;27:349-359.
7.
Smeeding SJ, Bradshaw DH, Kumpfer K, Trevithick S, Stoddard GJ: Outcome evaluation of the Veterans Affairs Salt Lake City Integrative Health Clinic for chronic pain and stress-related depression, anxiety, and post-traumatic stress disorder. J Altern Complement Med 2010;16:823-835.
8.
Maczkowiak S, Hölter G, Otten H: WATSU - The effect of differently accentuated movement therapy interventions on clinically depressive patients (WATSU - Zur Wirksamkeit unterschiedlich akzentuierter bewegungstherapeutischer Interventionen bei klinisch depressiven Patienten). Bewegungstherapie Gesundheits- sport 2007;23:58-64.
9.
Scaer R: The Body Bears the Burden: Trauma, Dissociation, and Disease. New York, Routledge, 2014.
10.
Faull K: A pilot study of the comparative effectiveness of two water-based treatments for fibromyalgia syndrome: WATSU and AIX massage. J Bodyw Mov Ther 2005;9:202-210.
11.
Gimenes RO, Santos EC, Silva TJPV: WATSU in the treatment of fibromyalgia: pilot study (WATSU no tratamento da fibromialgia: estudo piloto). Rev Bras Reumatol 2006;46:75-76.
12.
Marafon G: Tecniques of body mediation from alternative medicine - WATSU; in 9th Congress of the European Federation of Sexology, Rome, 2008.
13.
Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D; the CARE Group: The CARE Guidelines: consensus-based clinical case reporting guideline development. J Med Case Rep 2013;7:233.
14.
Munk N, Boulanger K: Adaptation of the CARE Guidelines for therapeutic massage and bodywork publications: efforts to improve the impact of case reports. Int J Ther Massage Bodywork 2014;7:32-40.
15.
HRA: Federal Act on Research Involving Human Beings: Human Research Act. The Federal Council of Switzerland, www.admin.ch/opc/en/classified-compilation/20061313/index.html, 2014.
16.
Zimmermann Y, Hölter G, Wassink K: ‘Achtsame' Körpererfahrung in der Psychomotorik. Motorik 2008;31:90-101.
17.
Bystrova K: Novel mechanism of human fetal growth regulation: a potential role of lanugo, vernix caseosa and a second tactile system of unmyelinated low-threshold C-afferents. Med Hypotheses 2009;72:143-146.
18.
McGlone F, Wessberg J, Olausson H: Discriminative and affective touch: sensing and feeling. Neuron 2014;82:737-755.
19.
Melzack R, Wall PD: Pain mechanisms: a new theory. Science 1965;150:971-979.
20.
Stratford P, Gill C, Westaway M, Binkley J: Assessing disability and change on individual patients: a report of a patient specific measure. Physiother Can 1995;47:258-263.
21.
Soderberg GL, Ballantyne BT, Kestel LL: Reliability of lower extremity girth measurements after anterior cruciate ligament reconstruction. Physiother Res Int 1996;1:7-16.
22.
Mayring P: Einführung in die qualitative Sozialforschung, ed 5. Weinheim, Beltz, 2002.
23.
Dull H: WATSU: Freeing the Body in Water. Victoria, Trafford Publishing, 2004.
24.
Craig AB, Dvorak M: Thermal regulation during water immersion. J Appl Physiol 1966;21:1577-1585.
25.
Tile M: Acute pelvic fractures: I. Causation and classification. J Am Acad Orthop Surg 1996;4:143-151.
26.
Gabbe BJ, Hofstee DJ, Esser M, Bucknill A, Russ MK, Cameron PA, Handley C, de Steiger RN: Functional and return to work outcomes following major trauma involving severe pelvic ring fracture. ANZ J Surg 2015;85:749-754.
27.
Nusser M, Holstiege J, Kaluscha R, Tepohl L, Stuby F, Roderer G, Krischak G: Return to work after fractures of the pelvis and the acetabulum (Berufliche Wiedereingliederung nach Becken- und Azetabulumfrakturen). Z Orthop Unfall 2015;153:282-288.
28.
Borg T, Berg P, Fugl-Meyer K, Larsson S: Health-related quality of life and life satisfaction in patients following surgically treated pelvic ring fractures. A prospective observational study with two years follow-up. Injury 2010;41:400-404.
29.
Lefaivre KA, Slobogean GP, Ngai JT, Broekhuyse HM, O'Brien PJ: What outcomes are important for patients after pelvic trauma? Subjective responses and psychometric analysis of three published pelvic-specific outcome instruments. J Orthop Trauma 2014;28:23-27.
30.
Morshed S, Knops S, Jurkovich GJ, Wang J, MacKenzie E, Rivara FP: The impact of trauma-center care on mortality and function following pelvic ring and acetabular injuries. J Bone Joint Surg Am 2015;97:265-272.
31.
National Institute for Health and Care Excellence (NICE): Workplace health: long-term sickness absence and incapacity to work; Public Health Guideline. www.nice.org.uk/guidance/ph19, 2009.
32.
Sundberg T, Petzold M, Kohls N, Falkenberg T: Opposite drug prescription and cost trajectories following integrative and conventional care for pain - a case-control study. PLoS One 2014;9:e96717.
33.
Baars EW, Kooreman P: A 6-year comparative economic evaluation of healthcare costs and mortality rates of Dutch patients from conventional and CAM GPs. BMJ Open 2014;4:e005332.
34.
Kooreman P, Baars EW: Patients whose GP knows complementary medicine tend to have lower costs and live longer. Eur J Health Econ 2012;13:769-776.
35.
World Health Organization (WHO): ‘Beijing Declaration' on Traditional Medicine. www.who.int/medicines/areas/traditional/congress/beijing_declaration/en/, 2008.
36.
World Health Organization (WHO): Executive Board and World Health Assembly Resolutions on Traditional Medicine. www.who.int/medicines/areas/traditional/trm_assembly_doc/en/, 2014.
37.
Vincent HK, Horodyski M, Vincent KR, Brisbane ST, Sadasivan KK: Psychological distress after orthopedic trauma: prevalence in patients and implications for rehabilitation. PM R 2015;7:978-989.
38.
Lindert J, von Ehrenstein OS, Grashow R, Gal G, Braehler E, Weisskopf MG: Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis. Int J Public Health 2014;59:359-372.
39.
Rolli Salathe C, Elfering A: A health- and resource-oriented perspective on NSLBP. ISRN Pain 2013;2013:640690.
40.
Becker BE: Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM R 2009;1:859-872.
41.
Antonovsky A: The salutogenic perspective: toward a new view of health and illness. Advances 1987;4:47-55.
42.
Synnott A, O'Keeffe M, Bunzli S, Dankaerts W, O'Sullivan P, O'Sullivan K: Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review. J Physiother 2015;61:68-76.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.