The Healing Environment of Water

By Rich Harris, MSc, CSCS, PTA, CES, CSAC

Aquatic therapy has tremendous rehabilitative potential for individuals of all ages, ranging from the treatment of acute injuries to overall health maintenance of many chronic diseases. Water therapy has been proven effective with a variety of conditions, including post-surgery rehabilitation, impaired balance, joint replacements, and chronic pain. Water provides physical properties that can help ease the rehabilitation process compared to land-based programs which can be inadequate for conditions such as osteoarthritis, fibromyalgia, joint replacements, anterior cruciate ligament (ACL) reconstruction, muscle weakness, gait disturbances, and neurological disorders.

Exercising in water provides benefits that land-based programs cannot offer due to the principles of hydrodynamics. The physical properties of water, such as viscosity, hydrostatic pressure, thermodynamics, and buoyancy, create tremendous biological changes as the result of water immersion.

Buoyancy for Unweighting

The buoyancy of water is created by submerging the body, which causes water displacement and the resultant force of buoyancy. To understand the benefits of buoyancy, consider that when the body is immersed in waist-high water to the umbilicus, approximately 50% of the weight of the body is reduced. Furthermore, when submerged to the chest, about 75% of the body’s weight is reduced.

The result of this buoyancy, especially for individuals affected by arthritis or joint-related pain symptoms, is the ability to move more freely in the water. Clients can perform movement and activities with considerably less pain than on dry land. Likewise, it allows the participant to move with greater ease due to the sensation of feeling lighter in the water.

Patients who suffer from osteoarthritis are able to walk and even jog in water, thus improving their range of motion, strength, fitness, and overall function. One study demonstrated that participants significantly improved knee and hip flexibility, strength, and aerobic fitness while performing aquatic exercise while rehabilitating from arthritis.

Gentle Resistance

Another attribute of water that creates an additional benefit to the therapeutic environment is hydrostatic pressure. Hydrostatic pressure is the pressure exerted by water on the body. This pressure improves circulation and provides more oxygen and nutrients to injured tissues as well as reduces edema from injured extremities. When moving or exercising in water, viscosity or the opposition of the water creates a sensation of drag or friction to the body that provides a gentle resistance that can be used to improve muscle strength. The greater the force the body applies to the water, the greater the resultant viscous force and therapeutic resistance provided. Therapeutic pool temperatures should be between 87 and 94 degrees in order to provide the most benefit regarding muscle relaxation, increased blood flow, and patient comfort to complement the other benefits of aquatic exercise mentioned previously.

Stepping Into Recovery

Underwater treadmills help accelerate the recovery process for patients by utilizing all of the aforementioned attributes that water provides. Patients have the option to walk or move in multiple directions or even jog in water while taking advantage of the many benefits water creates. Many patients are able to walk greater distances and speeds than they could by walking on land-based treadmills or outdoors on sidewalks or roads. Even older adult patients who have compromised balance or gait disturbances are able to walk safely and confidently without the fear of falling if the treadmill has side rails the patient can hold and use to help maintain their balance.

From a sports-related perspective, athletes can begin a more aggressive but safe rehabilitation process by running much sooner on an underwater treadmill than would be possible on land; providing them a head start toward returning to their sport. To illustrate this point, Vinit Patel (pictured) suffered an ACL injury while playing college football. He had ACL reconstructive surgery and with the approval of his surgeon, Patel began a running program on the underwater treadmill much sooner than a land treadmill would allow due to the many benefits of the aquatic environment. Buoyancy was particularly helpful in his case as it removed the stress of gravity from his newly constructed graft.

Moving Forward with Aquatics

Physical therapy clinics considering whether an aquatics program could be the next step in enhancing its services or expanding its client base have certain considerations to address, including the task of researching and identifying a full-size pool or modular unit that provides the needed features at an acceptable cost. Budgets and target clientele vary. For example, one clinic may need only a modular unit equipped with an underwater treadmill that accommodates a single user and fits within an existing gym area, while another clinic may have the resources to build out a new space with a below-ground pool equipped with a movable floor, underwater cameras, underwater treadmills, or resistance jets.

Ins and Outs of Pool Access

Clinics that install aquatic facilities will also need to address questions associated with how individuals will enter and exit the pool. This is especially important for clients who have limited mobility or motion-limiting pain, or who use wheelchairs or assistive devices. One solution is to install an ADA-approved pool lift. These are available from several manufacturers, which can be designed for above-ground or in-ground pools, and are equipped with features such as headrests, seatbelts, and flip-up arms.

The literature strongly supports participation in regular physical activity as a prevention strategy for improving health and preventing chronic disease. The Centers for Disease Control and Prevention (CDC) has recommended a weekly minimum of 150 minutes of physical activity to prevent the development of chronic diseases such as diabetes, hypertension, obesity, osteoarthritis, and cardiovascular disease. Many people affected by these conditions may find that the benefits of the aquatic environment allow them to be physically active and exercise more comfortably than land-based activity or exercise.