by Jennifer Leipzig, PTA, and Jenna Prijatel, PT, DPT
Athletico Physical Therapy has found success in offering aquatic therapy in a private, comfortable, warm-temperature environment when used as an adjunct to traditional “land-based” physical therapy. In the water the practice’s aquatic therapy clinicians use hydrostatic pressure, buoyancy, and viscosity along with other unique properties of water to achieve physical therapy goals. Aquatic therapy has a positive impact on pain management, physical function, and quality of life in those suffering from musculoskeletal conditions.
Why Water Works
Warm water provides a therapeutic environment much different from land due in large part to reduced gravitational and weight bearing forces. Athletico facility pools are kept at 93°F to increase blood flow, encourage muscle relaxation, and allow patients to move with less guarded movements and less pain. In turn, this helps to improve range of motion, strength, and stability to progress toward returning to prior level of function.
Hydrostatic pressure, or the pressure exerted by fluid molecules, acts similar to a compression wrap by providing even pressure around an injured joint to alleviate aches and pains and reduce swelling. In applicable terms, the deeper a limb is submerged in water, the greater the compressive force that is placed on that limb. This helps aid in venous return and creates a comfortable and easily tolerable compression, which assists in decreasing joint and soft-tissue edema. Because pressure is produced perpendicular to the body’s surface, the constant contact on the skin helps patients become more aware of where their arms and legs are in space and time. Finally, since the hydrostatic pressure of water pushes all body surfaces equally, it positively affects blood circulation and improves heart and lung function.
The buoyancy of water means weight bearing can be decreased at various depths, which helps patients gradually adjust to full weight-bearing land exercises during the recovery process and allows patients to begin low-impact exercises sooner than they may be able to on land. Patients with fibromyalgia and/or lower back and spinal injuries are among those who benefit from the joint relief buoyancy offers. For many patients, there is also an added benefit of removing the possibility of falling, which offers a positive psychological effect and builds confidence for land-based exercise.
In addition, the resistance felt as a result of the higher viscosity of water allows the muscles to work harder when compared to the same exercises on land. This viscosity ensures more muscle fibers are recruited for each movement through water and ultimately promotes body awareness, proprioception, and core stability to help provide stabilization for patients with gait dysfunction and balance disorders. Viscosity also helps build endurance and improve muscle tone and range of motion—using water’s resistance, coupled with water’s buoyancy, patients can strengthen muscle groups with decreased joint stress that would not be possible on land. Clinicians can successfully manipulate the viscosity of water with given resistance tools in order to achieve optimal rehab potential for patients.
Therapeutic Tools for the Aquatic Environment
The practice’s aquatic physical therapy clinicians use a range of pool equipment to manipulate viscosity of water and facilitate the entire kinetic chain to progress toward established goals. Many different pool accessories are used for either flotation or drag resistance. These accessories allow aquatic therapy clinicians to be continuously creative in strengthening desired muscle groups.
Common pool accessories used at the facilities include:
• Noodles: Used for upper extremity and lower extremity strengthening, balance, and support. Single-leg balance exercises are an example of how noodles may be used for therapeutic pool-based activities. For these exercises the noodle is placed under a patient’s raised leg so that it forms a U-shape. In the center of the U the patient places a foot and then holds the position for several seconds. This exercise can be repeated several times on each leg.
• Buoyant hand bars: These accessories can vary in size. The larger the hand bars are, the more buoyancy they provide. They are used for upper extremity strengthening, balance/support, and facilitation of the entire kinetic chain.
• Buoyant and resistant ankle cuffs: Effective for lower extremity/lower body strengthening and conditioning and core stabilization.
• Ankle weights: Used for lower extremity strengthening or for stability/control of a lower limb.
• Resistant hand bells or paddles: Facilitate drag resistance and can use the force and speed used to manipulate the drag, or resistance, of the water. These are used for upper extremity/upper body strengthening and to facilitate the entire kinetic chain for core stabilization.
• Kick boards: Used to sit, stand, and kneel on for upper/lower extremity strengthening, facilitation of the entire kinetic chain, and core stabilization. Kickboards offer a wide range of activity options for clinicians to use their creativity. One example is for the patient or client to use both hands to hold a kickboard partially submerged in front of the body. As the person runs through the water, he or she pushes the kickboard outward through the water in front. The continuous pushing/pulling of the large, flat kickboard surface creates therapeutic resistance for the exercise.
• Gloves: Increases viscosity of the water and also isolates the upper extremities for strengthening and stabilization. Webbed gloves can be used to perform arm raises, which call for the patient to hold arms at sides, bend elbows to 90-degree position, then raise the arms to the surface and return them back down while maintaining a 90-degree bend at the elbows. Several sets of this exercise may be performed.
• Cervical collars: Provides neck support and flotation for relaxation and breathing activities, and also allows the patient to remain in a supported supine/floating position to allow manual work of a clinician.
Pool accessories from a variety of brands are used in the practice’s programs. Variety, quality, and ordering convenience are factors taken into consideration while making purchasing decisions, with each product evaluated for value and the return it can provide to therapists, patients, and the practice.
In addition to the pool accessories, a pool lift chair is used for non-ambulatory patients. Aside from offering support for those who need assistance safely entering or exiting the pool, lifts have the added psychological benefit of reducing anxiety for patients with limited mobility who are uncomfortable entering or existing the pool. The therapy market is served by a number of providers who offer ADA-approved pool lifts for above-ground and in-ground pools. Design options vary, and a number of safety features are available, such as seat belts and flip-up footrests. Pool lifts for bariatric use are available as well as portable models, and models powered by battery or water pressure.
Aquatic therapy in a therapeutic pool is a great adjunct to traditional therapy for patients who have impaired mobility, neurologic impairments, weight bearing restrictions, are recovering from surgery, or suffer from arthritis and other chronic conditions. Athletico’s Aquatic Therapy Program is designed to be beneficial to nearly every client and patient whose goal is to increase strength, decrease pain, and improve function. By using the properties of water coupled with traditional physical therapy techniques, patients are provided with a comprehensive and effective treatment plan. RM
Jennifer Leipzig, PTA, is a licensed physical therapist assistant at Athletico Physical Therapy’s Kenosha, Wis, location. Leipzig specializes in aquatic therapy services and has been practicing in the water for over 18 years. This advance training was received by The Aquatic Therapy and Rehab Institute. Leipzig is also a Certified Pool Operator.
Jenna Prijatel, PT, DPT, is a physical therapist at Athletico Physical Therapy’s Kenosha, Wis, location. For more information, contact RehabEditor@allied360.com.