Since the earliest recorded history, water has always been believed to promote healing and has therefore been widely used in the management of medical ailments. Through observation and centuries of trial and error, and scientific methodology, traditions of healing through aquatic treatments have evolved.
This review will detail the current scientific understanding of the many physiologic changes that occur during aquatic immersion. Aquatic immersion has profound biological effects, extending across essentially all homeostatic systems. These effects are both immediate and delayed and allow water to be used with therapeutic efficacy for a great variety of rehabilitative problems.
Aquatic therapies are beneficial in the management of patients with musculoskeletal problems, neurological problems, cardiopulmonary pathology, and other conditions. In addition, the margin of therapeutic safety is wider than that of almost any other treatment milieu.
Knowledge of these biological effects can aid the skilled rehabilitative clinician to create an optimal treatment plan, through appropriate modification of aquatic activities, immersion temperatures, and treatment duration.
Simply put, aquatic physical therapy is the practice of physical therapy in the water. An aquatic program is designed by a patient’s physical therapist as part of an individualized treatment plan to achieve specific goals. The pools used are designed specifically for physical therapy and are often smaller and have adaptations (like handrails) to enhance patient comfort and accessibility.
Benefits of Aquatic Physical Therapy
Aquatic therapy can be beneficial for a number of different patients and is not utilized for specific diagnoses, but instead is used to address particular problems a patient may have including:
- Balance and coordination
- Muscle strengthening
- Increasing flexibility
One of the reasons aquatic therapy can be beneficial to patients is because the water absorbs most of the pressure our body weight typically puts onto our joints. By conducting physical therapy in the water, the body becomes more buoyant and decreases the amount of stress on your joints.
Aquatic therapy is typically used for patients who:
Are not allowed full weight bearing but need to work on walking
Need to work on jumping or landing but are unable to tolerate high impact activities
Are recovering from surgery
Are experiencing acute low back pain and cannot tolerate standing and walking
Are athletes and need to break down sport specific drills in a more controlled environment
Physical therapists at UPMC Sports Medicine have been utilizing aquatic therapy with patients for the past 15 years, and therapists at the new UPMC Lemieux Sports Complex will also incorporate aquatic therapy into treatment. The new complex will have the ability to assess patients with an under-water camera and monitor which will provide feedback on their performance.
Aquatic Therapy for Athletes
Recognizing the other potential benefits of aquatic therapy on strength and conditioning, the experts at the new UPMC Lemieux Sports Complex have begun incorporating it into recommendations for strength training plans. Water workouts allow healthy athletes to undergo a higher intensity workout while reducing the risks of injury and post-workout soreness.
Pat Garvey, DPT, the facility director of the UPMC Lemieux Sports Complex says, “Strength coaches favour water workouts because the impact to the athlete’s body is decreased so much that they are able to perform intense workouts multiple days in a row. Water is more resistant than air, so a water workout for 30 minutes has the potential to be as effective as a two-hour, intense dry land workout.”
Initially many people doubt the benefits of a water workout because they picture horsing around and goofing off in the pool. However, water workouts are far from easy. Take for example the below workout:
Jump in the pool and get your body moving. Anything you can do to get your heart rate up will work. We suggest walking or swimming a few laps if your pool is large enough. If your pool is smaller try jumping jacks or mountain climbers.
The next portion of your workout will depend on your specific goals.
For strengthening and agility try
- Forward kicks
- Side kicks
- Squat jumps
For speed, try interval running
- 15-second runs at 90% effort
- 5-second sprints at 100% effort
- 18 second high knees at 100% effort
Although water aerobics become popular in the 1970’s, the Godfather of fitness Jack LaLane, introduced a specific type of water exercise on TV in the 1950s. “To understand the roots of aqua therapy however, we must travel back in time. As far back as the Ancient Greeks water was believed to hold healing powers, and was used to treat all manner of ailments, later the Romans began to see the benefits of bathing in hot springs to improve circulation and aid relaxation. The beautiful Roman baths in Somerset are a testament to this.”
To get a better view of the timeline of aquatic therapy let’s take a look –
2400 BC, in Asia and Greece people immersed themselves in water as a healing and religious purposes.
The Ancient Greek physician Hippocrates talked about the attributes of bathing in spring water to alleviate the symptoms of some illnesses.
By 1500 BC, water was used to reduce fevers.
800 BC Bath, England became a hot spot for healing through bathing.
500 AD, not only did water as a form of therapy fall out of favour, so did bathing as a form of hygiene.
In the 1700’s water came back into fashion, with the emergence of hydrotherapy, developed by the German doctor Sigmund Hahn.
Today, Aqua exercise and therapy can be found in nearly every sports centre and health facility.
Aquatic Therapy – Applications in Cardiovascular and Cardiopulmonary Rehabilitation
Cardiac output increases by about 1,500 mL/min during clavicle depth immersion, of which 50% is directed to increased muscle blood flow . Because immersion to this depth produces a cardiac stroke volume of about 100 mL/ beat, a resting pulse of 86 beats/min produces a cardiac output of 8.6 L/min and is already producing an increased cardiac workload. The increase in cardiac output appears to be somewhat age-dependent, with younger subjects demonstrating greater increases (up 59%) than older subjects (up only 22%) and is also highly temperature-dependent, varying directly with temperature increase, from 30% at 33°C to 121% at 39°C .
During immersion to the neck, decreased sympathetic vasoconstriction reduces both peripheral venous tone and systemic vascular resistance by 30% at thermoneutral temperatures, dropping during the first hour of immersion and lasting for a period of hours thereafter . This decreases end-diastolic pressures. Systolic blood pressure increases with increasing workload, but generally is approximately 20% less in water than on land.
For lower back pain
“Water Exercises for Back Pain The effects of aquatic exercise on body composition and nonspecific low back pain in elderly males.” Khadijeh Irandoust, PhD and Morteza Taheri, PhD, from the Department of Physical Education, Imam
For chronic lower back pain
Aquatic Exercise for Chronic Low Back Pain Disability predictors in chronic low back pain after aquatic exercise Baena-Beato, Pedro Ángel PhD; Delgado-Fernández, Manuel PhD; Artero, Enrique G. PhD; Robles-Fuentes, Alejandro PhD; Gatto-Cardia, María Claudia BSc;
For pregnant women
“Safe Water Temperatures for Aqua Aerobic Exercise During Pregnancy Pregnant women maintain body temperatures within safe limits during moderate intensity aqua aerobic classes conducted in pools heated up to 33 degrees Celsius”, an observational study
“Water-based Exercise Combination for Postmenopausal Women The effects of water-based exercise in combination with blood flow restriction training (BFR) on strength and functional capacity in postmenopausal women” By Joamira P. Araújo, Gabriel R. Neto, Gilmário.