Aqua therapy is beneficial for many conditions.
What is Aqua Therapy?
Aqua therapy includes both exercises and treatments that are done in water for physical rehabilitation, relaxation, fitness, and other benefits. A heated pool is used, and a qualified therapist “gives constant attendance to a person receiving treatment”. The patient either floats or is partially or fully submerged in water. Physical functioning is improved for patients with injury, illness, or disability. Hydrotherapy is a type of water therapy that is part of alternative treatments, although sometimes that term is used for aquatic therapy. Aquatic therapy, on the other hand, includes many approaches, such as “aquatic exercise, physical therapy, aquatic bodywork, and other movement-based therapy in water (hydrokinesiotherapy)”. The treatment can be passive for the patient, where the therapist is the “giver” and the patient receives, or it can be active, in which the patient engages in “self-generated body positions, movement, or exercise”. Some examples of aquatic therapy are Ai chi, Bad Ragaz Ring Method, Watsu, Aqua Running, Burdenko Method, and Halliwick Aquatic Therapy. In terms of orthopedics and rehabilitation, aquatic therapy is the same thing as aqua therapy, therapeutic aquatic exercise, water therapy, pool therapy, and aquatic rehabilitation. This type of treatment has a role in sports medicine, joint arthroplasty, back rehabilitation, and work conditioning.1
Aqua Therapy Benefits and Considerations
Aquatic components are most beneficial for patients who need non- or limited weight bearing, or where the normal functioning of the patient is limited by pain, inflammation, muscle spasm, guarding, or poor range-of-motion. Aqua therapy is useful for those with weak muscles or neuromuscular impairment, such as patients with rheumatological disease, those who have an acute injury, and patients who are recovering from surgery. The benefits of aqua therapy are numerous. Water can be used to replace weights and gravity for resistance, it has thermal stability (constant temperature), it provides stabilization and support, flotation reduces gravity’s effects, and gentle movement and manipulation are assisted by “turbulence and wave propagation”.2 There are many benefits of aqua therapy. One benefit of aquatic therapy is that the “natural resistance” of the water can “dampen involuntary spastic movement and tremors” in patients with neurological impairments. Aqua therapy can also reduce anxiety and stress and provide “psychosocial benefits”. Aqua therapy could be useful for patients with traumatic brain injury (TBI), or others who are unable to exercise on land. It is beneficial that the patient “experiences pressure everywhere”, due to the hydrostatic pressure, which reduces edema and pain. Some patients, though, may feel a sensation of “squeezing in”. Another complication is that water might create stability problems for the patient and practitioner. Patients need to be kept in a “neutral spine position”. For some patients, being in a bathing suit in public is problem. Therapists should be compassionate about the patients’ feelings and be understanding when waiting for their patients to change clothes and enter and exit the water.3
In general, aquatic therapy is used to rehabilitate patients after an illness or an injury. The joints have reduced pressure in the water, and the water provides necessary resistance. The water’s warmth is helpful in reducing pain, increasing blood flow, and relaxing muscle spasms. Special jets may “help patients strengthen muscles and improve cardiovascular performance”. For those patients who have had trouble with traditional therapy, water therapy can provide fast improvement. In fact, hydrotherapy can be used to transition patients to land therapy “within 3 to 12 sessions”. Aquatic therapy is “ideal” for patients with arthritis, musculoskeletal disorders, chronic back, ankle, knee, or foot pain, spinal cord injury, stroke, brain injury, and for amputees. It can also be helpful for gait analysis, cardiovascular training, and lumbar stabilization. Aquatic therapy is designed to increase healing of injured tissue, strengthen tissues, and to improve flexibility, circulation, and “cardiovascular stamina”. Water could provide the necessary resistance for therapeutic and stretching exercises.4
Aqua Therapy Exercises and Techniques
Aqua physical therapy includes many exercises. Ai Chi, developed by Jun Konno in 1993, “uses diaphragmatic breathing and active progressive resistance training” so that patients can strengthen the body and relax. Aqua Running is used for cardiovascular conditioning, which is helpful to injured athletes. Athletes run in the deep water with a flotation device to keep the head above the water. With the Bad Ragaz Ring Method, the therapist assists patients with exercises while the patient lies horizontally in the water, supported by ring flotation devices. This is used to rehabilitate neuromuscular functioning. The Burdenko Method is designed to develop coordination, balance, endurance, flexibility, strength, and speed with “buoyant equipment to challenge the center of buoyancy in vertical positions”, and exercises at varying speeds and directions. The Halliwick Concept is meant to improve balance and core stability in disabled people. This aquatic therapy is also called Water Specific Therapy. Watsu is a type of “aquatic bodywork” in which the therapist guides the patient through “flowing movements and stretches that induce deep relaxation and provide therapeutic benefit”. It has been for use with disabled and injured patients.5
There have been many research studies into the effectiveness of water therapy in various types of patient populations. Recent research has been done on aquatic therapy in comparison with land-based therapy for patients with Parkinson’s disease. In a pilot study, patients with PD were evaluated, after receiving land or water therapy, to determine which treatment was better for self-movement and postural stability. Patients were randomly assigned to the control group (land) or experimental group (water) for twice-a-week sessions over 4 weeks. Both therapies showed improvement in the Functional Reach Test, but only aqua therapy patients improved significantly in other tests.6 Other research has been done for patients with Alzheimer’s disease, in which a case study found increases in arousal and alertness in an “nonambulatory patient”. A study on patients with MS found improvement in balance. The Halliwick-Therapy has been found to be helpful, in a study, for stroke patients. Andrea Salzman, MS, PT, and the founder of the Aquatic Resources Network, suggests that water therapy should be researched more in Alzheimer’s patients. This is because water may allow patients to be “challenged beyond limits of stability without the fear of consequences of falling”. Water allows for a longer reaction time and more safety, as well as other benefits such as the alertness and arousal mentioned earlier and motor and sensory input. Because “water is more viscous than air”, resistance is greater in water, and senses are stimulated by the drag provided.7 The increase in activity “promotes emotional well-being, improves appetite, reduces stress, and can even help residents rest easier at night”, and water therapy has “physical and emotional benefits” for memory care patients, according to a senior care facility in North Carolina.8 There is also an organization, Aquatic Physical Therapy International, that has a goal “to promote evidence based aquatic physical therapy around the world”. They support research about aquatic therapy so that “evidence based practice and clinical reasoning in aquatic physical therapy” can occur. APTI Membership is free for physical therapists and it “open to aquatic professionals with other health related educational backgrounds”. The APTI has a list of contacts throughout the world.9
Find out more about hydrotherapy.