October is National Physical Therapy Month. As we celebrate the Physical Therapy (PT) profession and the movement experts that make up this field, The O&P PT is focusing on a unique facet of PT: Aquatic Therapy.

Image from APTA

Aquatic Therapy 1,2

Aquatic therapy, also known as hydrotherapy, is a form of passive and active exercise combining resistance training and aerobic activity in a freeing environment. Consequently, this allows individuals with physical impairments to perform movements more easily than they could on land. The sense of satisfaction and the health benefits of aquatic exercise lead to greater strength, endurance, pulmonary function, mood and self-esteem. Additionally, aquatic therapy has been shown to improve pain management and sleep disorders.

Water Principles 2-4

Properties of water can be utilized to both assist and challenge a person during aquatic exercise. Many of these effects can provide health benefits. Hydrostatic pressure entails pressure exerted upon an immersed body which increases with depth. Breathing against the resistance of the water can improve pulmonary function and exercising below the water’s surface can reduce edema. Exercising in warm water can improve circulation allowing for muscle relaxation, improved joint range of motion, decreased blood pressure and increased metabolic rate. Buoyancy gives an individual the sense of weightlessness courtesy the opposing forces against gravity. Utilizing the depth of the water and a person’s density, the amount of weight-bearing can be altered. The deeper we enter, the less stress and effort is exerted by the body; a useful tool for individuals with limited muscle performance and pain. Adjustments need to be made for those with asymmetries (e.g., limb loss, hemiplegia, spasticity) as our bodies will rotate to meet center of buoyancy with center of gravity. Still water can provide an individual greater control for performing strengthening and balance activities, whereas increasing viscosity/resistance  by moving quickly through the water or moving against turbulent water can challenge the participant.  

Aquatic Therapy & Prosthetic Rehabilitation 1,4-8

Aquatic therapy can play a vital role for individuals with limb loss and limb difference helping to mitigate risk factors and augment function. Dysvascular disease accounts for >90% of amputations in our country and concomitant diabetes mellitus increases one’s risk for additional amputations. Aquatic exercise has been shown to reduce HbA1c and improve glycemic control in individuals with type 2 diabetes. Participating in regular aquatic therapy can be an effective strategy in the management of diabetes and a great way to improve overall cardiovascular health.  For individuals with unilateral lower limb loss, asymmetries in balance can lead to compensatory mobility strategies, postural anomalies, low back pain and musculoskeletal impairments. Aquatic therapy can improve balance, reduce pain, relax muscles and improve range of motion.

Image from APTA

Aquatic Therapy & Orthotic Rehabilitation 1,8-13

Orthoses may be prescribed for individuals with impaired balance & mobility, decreased strength, low or high tone, spasticity and impaired range of motion. Rehabilitation plays an integral role in helping orthotic users with acute and chronic impairments to improve their overall function and help reduce secondary issues. Aquatic therapy has been shown to help individuals with Parkinson’s, stroke, multiple sclerosis, cerebral palsy, spinal cord injury and traumatic brain injury. Neutral temperatures applied during aquatic exercise helps with spasticity management; often a vital treatment regimen in many of the aforementioned diagnostic groups. Hydrotherapy can increase strength, balance and body awareness. These are necessary components to fall prevention. While 1 in 4 adults ages 65+ experience falls per year, adults aged 45-59 with disabilities report higher incidence of falls than those 60 years and older. Ongoing fall prevention strategies and implementation of interventions like aquatic therapy are imperative in maintaining health. Additionally, the improvement in physical and emotional well-being associated with aquatic therapy has been reported with enhanced quality of life.


Reach out to your Physical Therapist today to explore aquatic therapy options in your area.

Image from APTA

References 

  1. APTA Academy of Aquatic Physical Therapy. “Academy of Aquatic Therapy 2024 Combined Sections Meeting Platform and Poster Presentations.” Journal of Aquatic Physical Therapy, vol. 23, iss. 1, 2024, 9-13. doi:10.1097/PXT.0000000000000036
  2. Broach,  E. “Evidence  based  practice  and  techniques  in  aquatic  therapy  for  recreation  therapy.” African Journal for Physical, Health Education, Recreation and Dance, Dec. 2012 (Supplement 3), 40-51.
  3. Faccini, P., Zanolli, S., Vedova, D.D. Aquatic Therapy in Rehabilitation. In: Puddu, G., Giombini, A., Selvanetti, A. (eds) Rehabilitation of Sports Injuries. Berlin, Heidelberg: Springer; 2001: 212-220.  doi:10.1007/978-3-662-04369-1_18
  4. Leonel, Larissa dos Santos, et al. “Aquatic training improves HbA1c, blood pressure and functional outcomes of patients with type 2 diabetes: A systematic review with meta-analysis.” Diabetes Research and Clinical Practice, vol.197, Mar. 2023, p. 110575. doi: 10.1016/j.diabres.2023.110575
  5. Moradi, Y., Behpoor, N., Ghaeeni, S. & Shamsakohan, P. “Effects of 8 Weeks Aquatic Exercise on static Balance in veterans with Unilateral Lower Limb Amputation.” طب جانباز 6, vol. 6, issue 2, 2014, 27-34. https://doaj.org/article/6f159518396b4374bf0388988e2a273a
  6. Esquenazi, A. & Kwasniewski, M. “Lower Limb Amputations: Epidemiology and Assessment.” PM&R Knowledge Now AAPMR,  29 June, 2021, https://now.aapmr.org/lower-limb-amputations-epidemiology-and-assessment/
  7. Cotrobas-Dascalu, VT, et al. “Effects of Kinesiotherapy versus Hydrokinetic Therapy on the Rehabilitation of Patients with Amputation.” Physical Education, Sport and Kinetotherapy Journal, vol. 62, issue 2, 2023, 174-188. doi:10.35189/dpeskj.2023.62.2.6
  8. Goicoechea, A. “An introduction to Hydrotherapy Rehabilitation.” AANLCP Journal of Nurse Life Care Planning, vol. 21, issue 1, Winter 2021, 26-32. https://research.ebsco.com/c/a7fbq4/viewer/pdf/c7jg4sewjn
  9. Chui, K., Jorge, M., Yen, S.C. & Lusardi, M. In: Orthotics and Prosthetics in Rehabilitation (4th ed.).St. Louis, MO: Elsevier; 2020.
  10. Veldema, J. & Janse, P. “Aquatic therapy in stroke rehabilitation: systematic review and meta-analysis.” Acta Neurologica Scandinavica, vol. 143, issue 2, Mar. 2021, 221-241. doi:10.1111/ane.13371  
  11. CDC. “Older Adults Falls Data.” CDC, https://www.cdc.gov/falls/data-research/index.html, Accessed 13 October, 2024
  12. U.S. Government Accountability Office. “Older Adults and Adults with Disabilities: Federal Programs Provide Support for Preventing Falls, but Program Reach is Limited.” GAO, 27 July, 2022. https://www.gao.gov/products/gao-22-105276
  13. Choose PT. “Find a Physical Therapist Near You.” APTA, 2024, https://www.choosept.com/find-a-pt