Benefits of Aquatic Physical Therapy

What is Aquatic Physical Therapy?

We all know that water is a vital part of our lives – one which we absolutely can’t live without. But did you know that it has healing powers too?

Water possesses unique properties that allow it to be an effective therapeutic medium, often referred to as aquatic physical therapy. The Academy of Aquatic Physical Therapy defines it as “the scientific practice of physical therapy in an aquatic environment by physical therapists and physical therapists assistants.” Simply put, it is the practice of physical therapy in water.

Aquatic Physical Therapy differs from aquatic exercise in that it requires the skilled service of a physical therapist while the latter does not. Aquatic therapy programs usually take place in an aquatic therapy room with dedicated space for hydrotherapy equipment, which may include whirlpools, water current therapy pools, full-sized swimming pools, plunge pools, and even aqua bikes and underwater treadmills.

This form of therapy is useful not only for a variety of medical conditions and a number of different patients but also as a form of training for athletes. It is important to note though that aquatic physical therapy is not for everyone. For instance, it is not recommended for those who have an extreme fear of the water or are diagnosed to have chlorine allergy, seizure disorders, incontinence, and open wounds or non-healing ulcers.

Aquatic Therapy as Training

Water therapy is not just for rehab. It can also be used by athletes for training and conditioning and for recovering muscles before and after practice. More and more athletes are now making use of aquatic therapy for cross-training because it is as effective as traditional, land-based training. Water fitness improves or maintains:

• Function

Aquatic therapy can help athletes in the support or restoration of function for many areas of orthopedics. Often, when normal functioning is limited due to pain, muscle spasms, inflammation, guarding or limited range of motion, a non-weight bearing therapy program is recommended and this is where a strong aquatic program, such as sports medicine, work conditioning, joint arthroplasty, and back rehabilitation program comes in.

The support provided by the water is the best thing about aquatic therapy. A person’s body is composed of mostly water. Being in the water reduces the person’s weight by nearly 90 percent, which alleviates pressure and pain on the joints during movement. This environment helps promote circulation and strengthen weak muscles and tensions.

• Aerobic Capacity / Endurance Conditioning

Performing aquatic exercises achieve equivalent results to land-based exercises, which is why many athletes use them for cross training to sustain or build aerobic fitness. They are especially useful to athletes who need to keep weight off a joint.

While aquatic exercises may not improve dry land performance in skills such as hurdles or high jumps, they have the ability to improve land plyometric training but with the side benefits of decreased post-training muscle soreness, decreased joint loading, improved performance, and increased respiratory function.

For instance, studies show that aerobic capacity among elite runners are enhanced via deep water running (DWR), which involves running suspended in water deep enough so that the foot does not touch the surface at any time. Another method involves the use of an underwater treadmill wherein athletes can perform exercises such as lateral shuffle, jogging, and butt kicks, among others.

• Balance, Coordination, and Agility

The ever-changing flow of water, called turbulence, provides a uniform hydrostatic pressure that helps stabilize and support the body. This gives athletes and other people with balance deficits an increased amount of time to react and perform exercises without the fear of falling, experiencing pain, or getting hurt. This, along with buoyancy, then improves balance and core stability.

One method used for this is called Ai Chi. Performing Ai Chi postures improve an athlete’s flexibility, core strength, trunk stabilization, and balance. Improvement on the athlete’s range of motion and mobility is achieved because the hydrostatic pressure lessens edema on the joints, while core muscles are strengthened by the soft, round flowing motions of the exercises.

• Body Mechanics and Postural Stabilization

There are a variety of methods used in aquatic therapy that contribute to improved body mechanics and postural stabilization, such as the practice of Yoga and Pilates. While these are typically land-based exercises, they can also be easily adapted to the water and can be tailored to fit an athlete’s specific needs in order to improve posture, strength, breathing, core stability, and flexibility.

Aquatic yoga and pilates involve performing non-impact movement patterns and poses in waist- to neck-deep water. The practice of poses and slow, controlled movements enables fluid motion and improves posture and balance.

• Flexibility

Flexibility exercises are as essential as burning calories and building muscle. In fact, they can also help improve sports performance, help athletes recover from aerobic activity, and also reduce their risk of injury. Benefits of flexibility exercises include better circulation, improved joint function, less back and joint pain, and improved muscle health.

Flexibility exercises, such as the AquaStretch, can be incorporated into aquatic therapy programs in varying depths of water. It has been reported as a superior stretching technique successfully used to increase flexibility in amateur athletes and even ballroom dancers and yoga instructors via athletic conditioning, athletic training, or athletic psychology.

• Gait and Locomotion

Re-establishing proper gait is essential for successful recovery following an accident, surgery or injury. This can be done successfully through aquatic therapy because of the reduction of gravitational forces in water.

Patients are often discharged from the hospital either completely non-weight-bearing or partially weight-bearing. This means that they have to adopt an altered movement pattern when mobilizing which affects their performance in their sport. This is challenging to correct when they become full weight-bearing again. To correct this dysfunction of walking and running gait on land, gait training can be used in the pool very early in the athlete’s recovery. Hydrotherapy allows the athlete to stand and train in the pool for the re-education of gait without causing further damage to his healing structures because the pool can reduce weight-bearing to 10%.

• Relaxation

The temperature of the water plays a big role in the benefits of aquatic therapy. Immersion in warm water helps increase the blood supply to the sore or tight muscles which increases comfort level and enhances relaxation.

The buoyancy provided by the water also helps in relaxation. Since the aquatic environment is decompressive, the buoyancy supports the person’s weight, reducing the stress placed on the joints which then gives relief from joint pains. This relief makes it easier and less painful for athletes to perform their exercises.

The Ai Chi method, for instance, also helps give athletes a calm meditative state of mind as it combines the use of deep breathing patterns and gentle movement.

• Muscle Strength, Power, and Endurance

Circuit training exercises can be done in the water via the use of devices such as float boards and Aquajoggers. These sessions, which may include exercises such as high-knee running, ball push-downs, forward and backward running, and swimming through the water with a kickboard, allows the athlete to alternate the use of different muscle groups which helps them mitigate muscle fatigue.

Water resistance also makes training in water harder especially at the deeper end of the pool. Instead of providing only one form of resistance like land workouts do, water workouts provide resistance in any direction, which allows athletes to strengthen their muscles with decreased joint stress.

Aquatic Physiotherapy as a Treatment

Aquatic physiotherapy is used to treat a multitude of different medical conditions:

• Sports Injuries

Injured patients are prescribed rest to recover. However, for those athletes not prescribed absolute rest, some form of exercise is still necessary so that he or she does not get back into his or her sport with significant loss of conditioning. In this case, a safe form of exercise like aquatic therapy can be recommended. It is safer than land exercise because the water’s resistance helps the person maintain balance while minimizing the risk of further injuries.

Aquatic training programs have been shown to benefit injured athletes. One of the benefits is a hastened healing process mainly because injured patients are more compliant, knowing that the exercises are relatively pain-free. There are also a lot of aquatic exercises specifically designed for athletes including those that are sport-specific.

• Post-Operative and Orthopaedic Conditions

After an operation, patients are normally required to undergo physical therapy, which traditionally meant land-based rehabilitation. Aquatic therapy used to be out of the question for patients post operation for fear of the possibility of wound infection.

However, studies show that early aquatic physical therapy helps to improve function and does not increase the risk of wound-related adverse events for adults after orthopedic surgery. Advanced and innovative hydrotherapy techniques and products are now available to ensure safe and successful rehabilitation even for early intervention post-op and as long as proper wound waterproofing techniques, water chemistry, and general best practices are followed.

• Spinal Pain and/or Injuries

Spinal pain and dysfunction can also be treated by aquatic therapy either as a sole approach or combined with a land-based program. Water is an ideal medium specifically for the rehabilitation of lower back injuries due to its unique physical properties.

Due to its weight support effects, aquatic therapy can benefit patients with spinal injuries through gait training, pain management, strengthening and toning as well as improvement of daily living activities. Another benefit is that aquatic therapy can lead to reduced spasticity, which is a persistent problem normally encountered in spinal cord injury patients.

•  Neurological Conditions

Neurological disorders that can be treated by aquatic therapy include Alzheimer’s disease, Bell’s palsy, brain injury, brain tumor, cerebral palsy, dementia, dizziness, epilepsy, multiple sclerosis, Parkinson’s disease, scoliosis, and vertigo. Patients with these disorders often experience a variety of challenges for treatment, such as weakness, hypertonicity, sensory loss, and postural instability, among others.

Aquatic therapy provides patients with a safe environment to practice movements and functional activities in an upright posture. The buoyancy of the water helps them build confidence as they increase functional mobility, regain trunk balance, and improve the range of motion, strength, and flexibility.

• Cardio-Respiratory Problems

Patients suffering from cardio-respiratory problems can benefit from an aquatic exercise program called Aquatic Cardiac Rehabilitation (ACR). This can help boost cardiac efficiency provided that certain exercise guidelines are met, including a physician’s referral, the patient’s history and physical, baseline ECG, and Exercise Stress Test, among others.

The temperature of the pool water is also a critical factor. Cold water can trigger arrhythmia while warm water can impede heat dissipation. The ideal temperature must be between 88 and 92 degrees F. A health professional must also be around at all times to monitor vital signs before, during, and after sessions.

• Balance Dysfunction

There are many possible causes for balance impairments including age, conditions that involve the loss of sensation in the feet and ankles, visual impairments or ear impairments among others. These conditions can cause dizziness and an increased risk of falls and serious injuries.

Vestibular therapy is usually prescribed to address balance, dizziness, gait, and fall prevention. However, aquatic therapy methods such as Ai Chi can also be utilized for fall prevention programs and developing lateral stability and stepping skills. The Halliwick Ten Point Programme is another method specifically developed to address balance and core stability using a combination of fluid mechanics and neurobiological responses of the body.

• Arthritis and Aged Care

The elderly and other people suffering from arthritis often find it difficult to find an exercise routine that works for them because a lot of them can be painful. In this case, water is the answer. Aquatic therapy benefits the arthritic patient because it can ease pain, reduce swelling, improve cardiovascular fitness, strengthen muscles, improve balance and range of motion.

Aquatic therapy exercises, such as water walking, are also low impact because the buoyancy reduces the pressure placed on the joints. Walking in water also requires more effort because it has greater resistance than air, which helps patients burn more calories compared to walking on land. Best of all, even those who don’t know how to swim can still take advantage of these because they are designed so that everyone can participate.