Aquatic Therapy: A Water Workout
By Amanda Hyman PT/S of Boston University
When asked to
determine the greatest contributor to body
weight, it is easy for one to suggest fat,
muscle, organs, or even bone. Although each
element is vitally important and equally
prominent, it is rather easy to neglect the most
abundant component of the human body - water.
Nearly 60% of the average adult body is water –
that’s roughly 45 quarts of fluid[5]. Given its
large presence in the body, it’s no wonder that
most individuals will naturally gravitate
towards the nearest wet oasis. For those seeking
relief from orthopedic injury and surgical
intervention, new trends in rehabilitation are
turning to water to alleviate pain and aid in
the return of function. But why?Today’s aquatic therapy utilizes the principles of hydrodynamics to engage the cardiovascular and musculoskeletal systems in a reduced weight-bearing environment. Once submerged, the natural properties of water make it an ideal medium for manipulating the human body. Buoyancy, or the tendency to float in water, provides a sensation of weightlessness and correlates to water depth. It reduces gravitational stresses and may be used in conjunction with flotation devices to assist movement towards the water’s surface or promote resistance when moved away[2]. Resistance is also created via the viscosity, or water density, which is naturally greater than that of air. Hydrostatic pressure also changes according to water depth, delivering constant forces upon the body that concentrates blood flow and stimulates proprioceptive mechanisms in the skin and joints[2].
In the management and treatment of orthopedic injury, water promotes and engages human movement without risk of joint trauma. Most aquatic programs focus on improving range of motion, strength, mobility, and endurance. Populations known to benefit from aquatic therapy include those with spinal and joint disorders or injuries, epilepsy, cerebral palsy, fibromyalgia, muscular dystrophy, multiple sclerosis, rheumatoid arthritis, osteoarthritis, osteoporosis, and spinal cord injuries[1]. Not only does the water assist in removing excess heat from the body, but it also reduces the impact shock contributing to muscle soreness and joint pain, increases energy expenditure, enhances tone, and promotes circulation[4]. It also releases tension, decreases arthritic pain, improves coordination, and promotes muscle balance. A 2007 study by Hinman et al. revealed improvements in pain, function, joint stiffness, muscle strength, and quality of life among 71 individuals with symptomatic hip or knee OA who participated in aquatic therapy as compared to control groups[6]. Similar results were observed in a 2007 study by Fransen et al. with significant improvements in pain and physical function among hip or knee OA aquatic therapy participants versus land-based groups[3]. Beyond its physical benefits, aquatic activity also aids in elevating self awareness and self-esteem, as individuals are engaged in a fitness-oriented environment conducive to positive social interaction.
For more than 15 years, Guilford Orthopedics has provided the general public with medically supervised aquatic therapy services as an alternative to land-based rehabilitation. Every Tuesday and Thursday afternoon, patients gather at the downtown Greensboro YWCA to participate in an hour of pool activity. Under the guidance of GOSMC’s experienced rehab specialists Julie Hutchins, ATC and Nikki Rogers, PT, patients perform a wide variety of exercises intended to optimize physical performance and reduce functional deficits.
As a Boston University physical therapy student on my first full clinical rotation, I had the unique opportunity to participate in GOSMC’s aquatic therapy sessions. With absolutely no prior experience in this realm of rehabilitation, it was an area where I was willing to get my feet wet. For a period of eight weeks, I had the privilege of joining the pool therapy participants, listening to their stories, and assisting with the design and/or management of their treatments directly in the water.
During my brief time at the YWCA, I have encountered several compelling stories of personal triumph and newfound liberation. The life-changing impact aquatic therapy has provided for some individuals is truly remarkable. On any given day, it is not uncommon to hear “I’ve never felt better”, “I feel so free”, or “I feel like I can move again”. Within the warm pool waters, patients feel uninhibited by their injuries. Independence is gradually enhanced with increasing self-motivated movement. Pain, heaviness, and immobility are temporarily forgotten for the afternoon. Feelings of vulnerability and weakness are gradually replaced by a renewed sense of self-confidence and fervent optimism. The weight that has been lifted from the human body provides an equal sense of relief within the patient’s mind, ultimately rebuilding one’s concept of self-image.
Indeed our anatomical physique is mostly made of water, but that’s not all it’s made of. Far greater than his or her separate parts, each person possess a unique, complex, and often unpredictable human body. Not allowing an individual to be defined by his or her injury, aquatic therapy provides an avenue to explore one’s ability and escape the confines of impairment. The foundation for a positive lifetime change begins simply by diving in.
References
1. Broach E., Dattilo J. (10 October 2000). Aquatic therapy: making waves in therapeutic recreation. Parks & Recreation, 31(7), 38-43.
2. Coberley M., Lawton R. (May 2000). Water sports. Advance for Directors in Rehabilitation, 37-40.
3. Fransen, M., Nairn L., Winstanley J., Lam P., Edmonds J. (28 March 2007). Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Arthritis Care & Research, 57(3), 407-414.
4. Gaines, M. (1993). Water exercise benefits. In Fantastic water workouts (pp. 3-7). Williston, VT: Human Kinetics Publishers.
5. Hansen J., Koeppen B., (2002). Body water. In Netter's Atlas of Human Physiology. Teterboro, N.J: Icon Learning Systems.
6. Hinman, R., Heywood S., Day A. (January 2007). Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blind randomized controlled trial. Phys Ther, 87(1), 32-43.