What is The Bad Ragaz Ring Method?

The Bad Ragaz Ring Method (BRRM) is a water-based technique in which AquaPhysiotherapist- assisted strengthening and mobilizing exercises are performed while the patient lies horizontally in the water, with support provided by rings or floats around the neck, arms, pelvis, and legs.

The extremities are used as levers to activate the trunk muscles

BRRM is based on proprioceptive neuromuscular facilitation (PNF).

PNF is commonly used in physiotherapy to enhance both active and passive range of motion, with the ultimate goal being to improve neuromuscular function using patterns of movement and therapist-assisted resistance.

BRRM was originally developed by physiotherapists in Bad Ragaz, Swizerland. It gets its name from the famous Bad Ragaz natural spring and wellness spa in eastern Switzerland. "Ring" refers to the rings or floats that are used to support the patient at the water surface.

Technique:

BRRM involves an Aqua Physiotherapist working one-on-one to guide a patient through specific patterns of movement and resistance, with the effect of muscular elongation and relaxation and associated pain modulation, and with the goal of improving neuromuscular functioning.

The method uses various properties of water for therapy, in particular turbulence and resistance, to restore anatomical, biomechanical, and physiological movements of joints and muscles in functional patterns. As with land-based PNF, BRRM recruits weak muscles by overflow from strong muscles and stimulates sensory awareness to rehabilitate neuromuscular function.

BRRM differs from land-based PNF in various technical details. In particular, on land the therapist moves around the patient and controls resistance; whereas in water, the therapist acts as a fixed point, while the patient controls resistance by varying the speed of movement.

Neck, pelvis, arm, and leg rings or floats provide support and correct positioning as the patient lies supine in waist to shoulder-depth water. Exercises are focused on increasing joint range of motion, increasing mobility of neural and myofascial tissues, and improving muscle function.

Conditions treated by BRRM:

1. Orthopaedic and rheumatology conditions (e.g., rheumatoid arthritis, spondylosis, osteoarthritis, including pre- and postsurgery, fibromyalgia, and ankylosing spondylitis).
2. Post fracture (e.g., spine, pelvis and lower limb).
3. Soft tissue injuries.
4. Thoracic or breast surgery.
5. Neurological conditions (e.g., cerebrovascular accident, spinal injury, Parkinson’s disease, head injury)

Sources:

• Dutton, M. 2011. Orthopaedics for the physical therapist assistant. Page 187 Bad Ragaz ring method. Jones & Bartlett Learning.
• Behrens, BJ and Michlovitz, SL. 2005. Physical agents: theory and practice, 2nd edition. Chapter 5. Aquatics and hydrotherapy. pp 82-89. F.A. Davis Co
• Prentice, W. 2011. Rehabilitation techniques in sports medicine and athletic training, 5th edition. Chapter 15. Aquatic therapy in rehabilitation. McGraw-Hill.
• Gamper, U and Lambeck, J. 2011. The Bad Ragaz Ring Method. In: Becker, BE and Cole, AJ and (eds). Comprehensive aquatic therapy, 3rd edition. Washington State University Press.
• McAtee RE and Charland J. 2007. Facilitated stretching: PNF stretching and strengthening made easy, 3rd ed. (Chapter 2. Focus on facilitated stretching, pp 11-18). Human Kinetics.
• Ainslie, T. 2012. The concise guide to physiotherapy - 2-volume set: Assessment and Treatment. pp 1096-1106, Bad Ragaz Ring Method. Elsevier Health Sciences.