The buoyancy and warmth of aquatic therapy pools eases clients’ joint pain and spinal pressure, enabling a more comfortable, and often effective, session.

An injury can do more than just sap strength; it can also weaken confidence and resolve. Offering a safe, secure environment is the best way to get patients to embrace therapy, and the best way to do that might be getting them in the water.

“If somebody is really concerned about falling—especially with a total knee [replacement] or maybe that’s how they were injured—the water is very safe and comforting,” says Todd Pratt, OT, co-owner of Aquatic Fitness Inc in St Louis. “Because it’s warm water, it’s like a bathtub. Suddenly they’re thinking, ‘Wow! This isn’t as bad as I thought it would be.'”

Pratt currently operates two clinics in the St Louis metropolitan area, along with his wife and co-owner, Jan Pratt, PT. Though their initial focus was primarily work-related injuries, their practice has since diversified to where only half of the clients are workers’ compensation cases. The remaining half comprise personal injury, Medicare, or private insurance patients.

SHOWING UP IS HALF THE BATTLE

Entering into the specialty of aquatic therapy may have happened by chance, but for Todd Pratt it was pure luck.

“We grew to have a passion for it, because I’ve seen what water can do for the patients that isn’t possible when you’re treating on land,” he says. “Water is such a good therapeutic medium; it’s more comfortable for the patient, and it takes a load off the joints and the spine.”

Alleviating that pressure means the patient is more comfortable—and will most likely have greater motivation to actually come to each session and progress in their programs. Because the water physically supports each individual, it’s also possible to get patients to begin therapy much earlier.

“When we started 10 years ago on land, physicians would allow us to start therapy on patients 6 weeks postsurgery,” Pratt says. “Now we get them in sometimes as soon as 5 to 10 days; because it is that much faster, we are able to get started and get them to functional independence.”

And getting patients out on land is the ultimate goal.

“It’s important to have the goal to get them to land, because that’s where they’re going to be functioning,” Pratt says.

Therapist Jennifer Kropatsch, MPT (upper left, corner), monitors her clients’ core/trunk stability exercises. They use handheld devices that simulate pulling and pushing activity and increase upper-extremity resistance.

PERSONAL ATTENTION

At Aquatic Fitness, initial patient analysis is always done on land—and always one on one—using a computerized evaluation system that determines a patient’s current limitations.

“The reliability is very high, so when the patient is re-evaluated, it will directly correlate to your initial reading and show if they have improved or have had some trouble and decreased,” Pratt says. “The information is automatically printed out in a report, which is very easy for the physician to read and understand.”

Based on the patient’s limitations, the therapist establishes a comprehensive aqua program incorporating stretching, strengthening, and cardiovascular components. Patients are usually prescribed three 1-hour sessions each week.

Getting patients into the pool can sometimes be a challenge. On more than one occasion, Pratt has worked with patients who either could not swim or had a phobia of the water. Again, building confidence is key.

“Our therapists tell them from the beginning—the worst thing that could happen to them is that they get their hair wet,” Pratt says. With tentative clients, PTs fill the pool with 4 feet of water and then climb in alongside them. Patients can decide to either sit or stand until they are comfortable, at which point the water depth is slowly increased. “It’s very safe, and we’ve even had people who had never been in the water before. We actually taught them how to swim.”

Pratt and his team are also committed to fostering a close relationship between therapist and patient. One therapist follows the patient through their entire rehabilitation process—from water to land to discharge. Not only do patients appreciate the friendly face, but it allows for a continuity of treatment welcomed by clinicians.

TAKING THE PLUNGE

Both Aquatic Fitness locations make use of an aquatic-therapy pool, each of which measures 18 feet long x 10 feet wide and boasts multidepth capabilities. The pool is partially submerged in the ground, and its depth can be raised or lowered to accommodate the ability of the patient being treated.

Though he selected them because they fit well into the physical location of the practice, Pratt believes that the specialized pools offer a variety of perks. For instance, the pools include technology that creates an adjustable current in the water.

“We will change the current during patient treatments, using pulses to challenge the upper extremities or other exercises depending on their injury,” Pratt says. An example would be simulating pushing or pulling a cart—a common workplace task. “We have something similar to a double-bladed kayak oar to simulate that motion. Then we use the current to increase the resistant of the ‘cart.’ “

Which isn’t to say aquatic therapy can’t be performed successfully in a “still-water” pool.

“I definitely feel you can use that type of pool just as effectively, though you might have to be a little more creative,” Pratt says. “You would have to create your own current, or you might have to use more pool equipment.”

But freestanding, larger pools also possess several advantages over therapy pools. The biggest benefit being—well, they’re bigger. The extra space provides ample room to generate resistance by moving the patient through the water.

With few exceptions, Pratt believes aquatic therapy is beneficial to most patients. Not only can they typically start therapy more quickly, but often they are inclined to continue the commitment beyond what is medically suggested.

“One of the benefits is that patients really see the advantage of maintaining that functional level in the pool on their own,” he says. “Just seeing the value in that and being able to maintain that is critical for the long term.”

A FLOTILLA OF TOOLS

When therapists at Aquatic Fitness step into the pool with their clients, they don’t come empty-handed. The usual suspects—such as pool noodles—are available, but so are a host of more creative options.

Always keeping an eye to getting the patient back on solid ground, cardio conditioning plays a huge role in virtually every rehabilitation program. One way this is achieved is with the use of a buoyancy belt, which enables patients to remain upright and “run” in place in the pool.

“They wear a heart rate monitor and, depending on their level, they may have a tether behind to support them,” Pratt says. “Then we just grade the flow of the water to make it more difficult and increase their heart rate, which is our objective.”

Jennifer Kropatsch, MPT (upper left), guides her client (who wears a heart rate monitor) through a non-weight-bearing cardiovascular workout.

To simulate weight lifting, patients can use webbed gloves, resistance tubing, or dumbbell-type equipment specifically designed for the water. When teaching proper lifting techniques, therapists will often enlist crates. Foam rollers can be used during abdominal and back-strengthening exercises. The team also uses something known as the “wonder board.”

“It’s analogous to a Swiss ball on land, so you can use it for lumbar-stabilization exercises in the water,” Pratt says. Sitting on the wonder board in the pool can prove quite challenging, strengthening the muscles required to constantly readjust the body and keep it upright. “It’s a high-level exercise, so somebody would have to progress to a level where they are able to tolerate it.”

LAND AHOY!

Specifically when dealing with on-the-job injuries, the ultimate goal is to gain enough strength so that work-related tasks can be performed with ease. To this end, a lot of focus is put on the teaching of proper body mechanics, which is easier to do in the water because the patient is completely supported.

“Water also makes it easier for repetitive movements, with both upper and lower extremities,” Pratt says. “It’s a better place to increase your strength and range of motion, because there’s no stress on the joints.”

For non-work-related injuries, the goal is the same: to get the individual back to a healthy state.

“The big goal in our eyes is to make them functionally independent, which might be done through job simulations or it might be simulating tying their shoes in the water,” Pratt says. “It’s still functional; it’s just about being more independent at home.”

Dana Hinesly is a contributing writer for Rehab Management. For more information, contact .