What is Aquatic Therapy?

Aqua therapy (or aquatic therapy) has become a popular physical therapy technique amongst physical therapists and sports therapists. During aquatic therapy, water becomes a therapeutic exercise medium.

A pool is the safest environment to perform the aquatic exercise, due to the low impact of physiological loads in the water (as compared to traditional land-based therapy). In this article, we will explore the benefits of aquatic therapy, its challenges, and its techniques.

The different types of water therapy:

• Aqua therapy: uses mechanical and thermal characteristics of water during partial or complete immersion, in combination with the effects of movements.
• Hydrotherapy: simply means the complete immersion inside the water.
• Water therapy: is where water is used as a direct medium, for example as an ice bath, contrast bath, or whirlpool.

Aquatic therapy can be beneficial and useful in the treatment of everything from orthopedic injuries to spinal cord damage, chronic pain, cerebral palsy, multiple sclerosis, stroke, and many other conditions.

Aqua therapy is also widely accepted as a preventative maintenance tool to facilitate overall fitness, cross-training, and sports-specific skills for healthy athletes. It improves blood flow and promotes muscle relaxation.

Other than that, aquatic therapy can also be implemented in general conditioning, strength, and a variety of movement skills training.

The temperature of the water inside the pool can be varied according to the patient’s condition. For athletes, the temperature ranges from 26°C to 28°C, while for patients with arthritis or neurological conditions pool therapy must be performed in warm water – the temperature must be maintained between 29°C to 31°C. This is to ensure the aqua therapy treatments are delivered appropriately.

An athletic trainer or physical therapist must understand several physical properties of the water before designing an aqua therapy program. Natural buoyancy is one of the primary forces involved in aqua therapy.

Whether on land or water, all objects are subjected to the downward pull of the earth’s gravity. However, in water, this force is counteracted (to a certain degree) with an upward force. The buoyancy force assists motion towards the water’s surface and resists motion away from the surface.

Thus, a person entering the water experiences an apparent loss of weight. Due to the decrease in body weight produced by the buoyant force, every joint inside the water is decompressed and unweighted. This allows for greater locomotion and vigorous exercise to be performed with little impact to the joints. The buoyant force also helps remarkably reduce the friction between articular cartilage within the joints. Hence aqua therapy is highly recommended for arthritis patients. The diminished pressure on the joints helps in relieving pain and reducing edema.

Applications and benefits of Aqua Therapy

There are many applications to perform aquatic therapy. Depending on the healing process, different elements of aquatic therapy should be applied.

In the early rehabilitation phase, aquatic therapy benefits athletes and patients in restoring range of motion and flexibility. Resistance training and sports-specific training can be added as the normal function is restored.

The slow-motion effect in water allows the patient to more easily experience multi-angle movement errors without any severe consequence (due to the reduced joint pressure). It also assists patients in regaining balance and proprioception as the fear of falling or re-injury is significantly reduced.

The turbulence function in aqua therapy gives the perturbation challenge that helps further restore coordination and balance. In addition, hydrostatic pressure helps in edema reduction which together benefits pain reduction and increases range of motion.

Buoyancy in Aqua Therapy

The natural buoyancy principle in aqua therapy can provide a gradual improvement from non-weight-bearing to full weight-bearing traditional land-based therapy. This gradual transition helps reduce pain and ensures smooth coordinated movements.

Buoyancy force reduces the apparent weight and joint compressive forces, meaning locomotor activities (gait training) can begin earlier following a lower limb injury. Aqua therapy is psychologically boosting the athlete to work out without fear of re-injury and helps patients’ bodies return to their normal function.

Building Muscle Strength

Furthermore, aqua therapy supports building muscle strength and re-education. The intensity can be controlled by manipulating the flow of the water turbulence, allowing minimal muscle contraction and transition to a resistive workout when the athlete is nearing full recovery. Aqua therapy requires more energy expenditure in comparison to land exercises as the patient needs to overcome the resistive force of the water.

Relaxation and stabilization

Finally, for neurological conditions, aqua therapy also provides relaxing effects and the warmth of the water helps in relaxing muscles and reducing muscle spasms. In addition, it also helps with regaining the trunk balance and promotes lumbar stabilization.

Aqua therapy helps in cardiorespiratory fitness through alteration in cardiovascular dynamics due to hydrostatic force. In addition, the heart functions more efficiently in water. As an added bonus, aqua therapy also helps reduce stress and promotes overall relaxation.

Injuries that benefit from Aqua Therapy

Aqua therapy can be beneficial for most of the orthopaedic and neurological condition/ injuries. Such as:

Challenges of Water Therapy

Getting started with aqua therapy

The primary disadvantage of aqua therapy is the cost of building and maintaining the rehabilitation pool. Besides that, qualified pool attendants must be present and the therapist must be trained in aquatic safety and therapy procedure. The aquatic therapy practitioners must pay careful attention to any patients who have difficulty in stabilizing.

Water temperature

Moreover, the water temperature plays an important role throughout the rehabilitation session. Warm water temperature that is greater than body temperature will increase the core body temperature more than land-based exercises would. On the other hand, water temperature lower than body temperature will decrease the core temperature and may cause shivering or even muscle tension.

Finally, aqua therapy also contains an inherent risk of drowning for those who are not used to water therapy. Thus, aquatic exercise should never be performed in deep water if the patient is alone.

Contraindications and precautions

There are many contraindications and precautions that must be taken into consideration by aquatic therapy practitioners before beginning the aqua therapy session with their patients or athletes. It is imperative to create a safe environment for patients.

The most common contraindication are an open wound, unhealed surgical scars, or contagious skin diseases. This must be restricted to prevent the chance of infection to the patient or others who utilize the pool.

Those experiencing fever, urinary tract infection (UTI), menstruation, allergies towards pool chemicals, heart problems, and uncontrolled seizure (increased risk of drowning) are also recommended against the use of aqua therapy.

Safety precautions must be taken if the patient has uncontrolled high or low blood pressure and also patients with uncontrolled bowel or bladder incontinence.

In addition, there are some injuries that are not suited for aqua therapy. For example, as much as the multiangle motion helps in balance and proprioception, it also can be contraindicated to PCL Reconstruction as the water resistance will cause posterior tribal translation. PCL Reconstruction may require a longer period to ligamentize, hence aqua therapy may not be advisable for the early phase of rehabilitation.

Safety of aquatic exercise programs

Finally, there are a number of safety measures that must be in place during aqua therapy. Oftentimes aqua therapy patients are uncomfortable or unfamiliar with deep water. The therapist must understand that swimming ability is not mainstream, but of course, highly recommended to participate in aquatic therapy.

Clear instructions on water safety skills help in conducting satisfying and safe rehabilitation sessions. In the initial stage, an exercise bar, ring-shaped flotation devices or floating noodles may be needed to assist with ambulation in water. This will also help decrease fear and stress for the patient and reduce stress to the injured area.

Facilities and equipment used in Aqua Therapy

Some aqua therapy pools come pre-fabricated with an in-water treadmill, exercise bike, or a current-producing device. A current-producing device is integrated into more advanced pools. They often also incorporate moveable floors or resistance jets to generate and control added resistance while training in the water. Therapeutic massage jets to massage underwater, and computer monitoring & recording systems to assess patient movement during aqua therapy can also be part of a fully equipped pool. Although these devices can be beneficial they are not essential for all treatment purposes.

Other equipment used in aqua therapy are therapeutic water running belt (for aqua running), therapeutic kickboard, floaty dumbbell, and sausage floats.

Sports-specific equipment can also be used if it is safe to go into the water (such as a racquet). Creative usage of one of the floating tools or actual sports equipment (baseball bats, tennis racquets, golf clubs) are helpful to incorporate sports-specific activities that challenge the athletes with familiar movements.

Equipment or pool toys are limited in usage; thus, the therapist must be creative in designing their rehabilitation program to achieve the targeted goals. Besides that, the aqua therapy program also must stimulate the patient’s interest and motivation for therapy to help achieve their goals in line with the therapist’s program.

Besides this, the use of proper clothing is also important. Wearing swimwear shows aquatic professionalism, while proper aquatic foot ware provides stability and traction, prevents injuries, and maintains good foot positions.

Aqua Therapy vs Swimming

Swimming could be incorporated as an aquatic exercise into your training regimen. It usually consists of four major strokes: freestyle, backstroke, breaststroke, and butterfly.

In general, swimming helps improve flexibility, muscle strengthening, and cardiovascular fitness. Aqua therapy has similar effects, however primarily involves physical movement focused on the injured area whereas regular swimming trains the entire body.

YES! Aqua therapy should be part of your physical therapy

The benefits of aquatic therapy are apparent. Aqua therapy offers positive psychological and physiological effects during the early rehabilitation of acute injuries and also chronic pain.

More beneficial effects are relieving pressure from the joints by eliminating or drastically reducing the muscle spasm and joint stress, improving blood flow, and increasing functional mobility. This helps patients to return to their normal daily activities without fear of pain or potential re-injury.

As healing and rehabilitation progress, both water and land exercises must be conducted to achieve the desired goals. Occasionally, aqua therapy will be continued for strength and conditioning training for patients with painful responses to land-based activities. For example, clients suffering from disc dysfunction, spinal stenosis, or osteoarthritis would all benefit from aquatic exercise.

Fundamentally, the swimming pool is therefore not only used for swimming: It can also be used as a medium for treatment and rehabilitation.

Do not make the mistake of taking Google’s word as scripture, consult a therapist now. If you want to know more about Aqua Therapy, feel free to give us a call at 03-50315946 or send us a Whatsapp or Make an Appointment. We at Rehamed Therapy are always here to help!