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Article written by Emily Dunlap, PT
WHAT MAKES THIS PARTICULAR AREA OF PHYSICAL THERAPY UNIQUE?
Aquatic physical therapy is unique because of the medium in which it
takes place - water. Aquatic exercise has become extremely popular
and for good reason. The properties of the water allow for a great,
safe workout. A specialist in aquatic physical therapy is
knowledgeable in how to use the properties of water to enhance
rehabilitation. Let¹s review these some of these properties and
how they may apply to you.
Buoyancy - Buoyancy is the upward force which is opposite to
gravity. This allows the immersed person to have less apparent weight
than on land. This can be beneficial if a person has weight bearing
difficulties. An example would be someone after a knee surgery who
cannot place full weight on the leg while it is healing. This person
would need to use crutches on land but may be able to walk in the
water without the crutches (depending on the amount of weight bearing
limitations imposed by the doctor). Another example would be someone
with arthritis or back pain who has cannot exercise on land exercise
due to the loading on the joints. These people would be able to
exercise in the water with more success than on land.
Viscosity - This refers to the internal friction specific to
fluid. There is more friction when moving in water than when moving
on land. This friction provides resistance with water exercise. The
resistance can be easily adjusted. The faster the movement through
the water the more resistance is given. This allows the person to
easily progress their workout without having to fuss with changing weights.
Hydrostatic pressure - This refers to the pressure the water
exerts on an object immersed in the water. The pressure is greater at
deeper depths. (This is why divers have to equalize the ear pressure
when diving deep depths). When exercising in water while standing the
pressure is greater at the feet and less on the chest. This pressure
difference allows for edema/swelling reduction (especially when
combined with exercise). This is beneficial for people with swelling
in legs or ankles.
WHAT SPECIAL SKILLS MIGHT A SPECIALIST IN AQUATIC PHYSICAL THERAPY HAVE?
Most physical therapist have some education on aquatic therapy but a
specialist in aquatic physical therapy has chosen to focus their
interest in this area. Presently, there are no regulating standards
to become an aquatic physical therapist specialist. Usually
specialists have taken continuing education on ...
1. water hydrodynamics
2. physiologic effects of water immersion
3. contraindications to aquatic therapy
4. water exercise for different patient populations
5. use of water exercise equipment
6. swim stroke analysis and modification
7. training in manual aquatic techniques or hands-on work done in the
water to address soft tissue restrictions, strength deficits,
postural or movement deviations and pain control.
A specialist in aquatic physical therapy may also have a specialty in
treating a certain patient population such as pediatrics, neurologic,
musculoskeletal, athletic injuries or chronic pain.
HOW WOULD SOMEONE ACCESS A SPECIALIST IN AQUATIC PHYSICAL THERAPY?
WHAT WOULD SOMEONE LOOK FOR IN AN AQUATIC PHYSICAL THERAPIST?
Word of mouth is a good way to find a qualified specialist. Ask your
physician or friends if they know an aquatic physical therapy
specialist they can recommend. If you cannot find a referral you can
check with the American Physical Therapy 1-800-999-APTA and ask for a
representative from the Aquatic Physical Therapy Section to contact
you. This professional organization should have a list of members in
your area. You can also look for physical therapy practices in you
area that have a therapeutic pool and call the facility and ask for
the qualifications of staff who do aquatic physical therapy.
Here are some suggested questions to ask an aquatic facility.
1. What is the temperature of your pool?
General guidelines - 90 degrees or cooler for athletic injuries,
90-92 degrees for musculoskeletal injuries, higher functioning people
with neurologic injuries and people with arthritis/ rheumatalogical
conditions , 93-96 degrees for lower functioning people with
neurolgic injuries and severe arthritis/ rheumatalogical.
2. What is the size and depth of your pool?
This can range from large lap pools to small swim tanks. Some have
varying depths and deep ends some do not.
3. Who staffs the pool? Will a licensed physical therapist or
assistant work with me? Will someone be in the pool with me?
This can vary quite a bit. Avoid facilities that do not staff the
pool with a licensed physical therapist or licensed physical
4. What are the qualifications for the aquatic staff person?
Again, look for a licensed physical therapist or physical therapist
assistant. Ask about any aquatic continuing education or specialty
aquatic techniques the staff member is trained in. Some examples
include Bad Ragaz Ring Method, Halliwick Method, Watsu, Feldenkrais,
Ai Chi, swim stoke analysis - just to name a few.
5. Do you have any community classes or an independent water exercise program?
Some facilities offer community programs to allow for transition into
a maintenance program after the therapy is completed. This is
desirable because you may get so much benefit from the water exercise
that you would want to continue with it after the therapy is over.
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WHO IS APPROPRIATE FOR AQUATIC PHYSICAL THERAPY?
Almost everyone can benefit from pool exercise but there are some
conditions that are ideal for the aquatic environment. Typically
people with these conditions have difficulty exercising on land and
the water provides them the ability to workout and stay fit.
Low back pain/dysfunction
Knee or ankle pain/dysfunction
Following surgery for back, hips, knees, ankles, shoulders
Spinal Cord Injury
Children with development disabilities
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WHEN DO I NEED TO SEE AN AQUATIC PHYSICAL THERAPIST VERSES JUST
GOING INTO AN AQUATIC CLASS?
It is advisable to see a physical therapist if you need an
individualized water exercise program. This would be the case if any
of the following are true...
1. You have just sustained a new injury
2. You have recently had a surgery
3. You have had difficulty with swimming or a water exercise class in
Physical therapy also provides education and manual therapy
(specialized hands-on work such as soft tissue massage) to help with
the following ...
1. control pain
2. improve flexibility
3. correct postural or gait deviations
4. increase strength
5. improve body mechanics with work and daily activities to avoid re-injury
WHAT MIGHT A TREATMENT INVOLVE?
Typically the first visit will not be in the water but rather an
evaluation done on land. The physical therapist would take your
history and ask about your desired outcome goals for the treatment.
She/he would do an evaluation to assess any problems with strength,
flexibility, posture and movement. Typically you will be given
education on your injury and suggestions on how to adapt your
lifestyle to maximize your function and prevent injury/re-jury.
Manual treatment and exercise instruction may begin on the first
visit. If time allows you may also go into the pool on this visit but
often this will happen on the second visit. Based on the findings of
the evaluation the therapist will decide when your treatment will be
in the pool and when it will be on land or if you will do both on one
day. When you are in the pool the therapist will instruct you in
water exercise to address your problem areas and also do manual or
hands-on therapy to facilitate your recovery. A good aquatic physical
therapy will always integrate both land and water to maximize your
WILL I NEED TO KNOW HOW TO SWIM?
WILL MY EARS AND HAIR NEED TO GET WET?
Many people mistakenly think of swimming as the only form of water
exercise. If fact for some people swimming can be harmful depending
on their diagnosis, fitness level and swimming ability. In aquatic
physical therapy there will be many different types of exercise to do
in the water. Some use equipment and some do not. Many times swimming
is not even included in the physical therapy program. You do not need
to know how to swim or get your ears or head wet to participating in
aquatic physical therapy.
If you have any further questions about aquatic physical therapy you
Emily Dunlap, PT
Clinical Director of Aquatic Physical Therapy
MORE Therapy Clinic
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