Aquatic Therapy: Why Water Works Wonders

Thousands of years ago, the ancient Romans and Greeks bathed in hot springs to relax and improve circulation. As early as 1238 AD, Swiss monks would lower disabled or sick people into thermal waters to decrease their pain and improve flexibility.

Our ancestors might not have known it, but they were laying the foundation for aquatic therapy.

Aquatic therapy is a type of physical therapy that takes place in a heated pool. Even though its roots go back thousands of years, the actual practice of aquatic therapy is fairly new.

Although aquatic therapy generally takes place in a swimming pool, it's a little different than jumping in and going for a swim.

Colleen DiBernardo, PT, MPT, Lead Aquatic Therapist at Chester County Hospital (CCH), explains how CCH's aquatic therapy program benefits many types of patients.

Q: Who is aquatic therapy ideal for?

Colleen DiBernardo: One of the benefits of aquatic therapy is that it can be therapeutic for a wide variety of patients. It works well for people with arthritis and chronic pain or who are recovering from surgery. But we also see many patients who have problems with tendons and joint pain in shoulders, hips, knees, ankles, etc. We also treat individuals who have problems or pain in their neck or back, such as herniated discs and sprains/strains.

Aquatic therapy is particularly good if you have multiple diagnoses. In the water, we treat the whole body, rather than a specific part.

Q: Is there anyone who shouldn't be doing aquatic therapy?

A: If you have open wounds or problems with bladder or bowel control, you cannot do aquatic therapy. Other than those conditions, there are very few conditions that limit a patient's ability to participate in aquatic therapy.

If your physician thinks aquatic therapy is right for you, we can usually make it work. It doesn't matter how old you are, or whether or not you have developmental disabilities. We also have a chair lift so you can still do it if you have trouble with stairs.

It's a decision based on the unique circumstances of each patient.

Q: Can you describe what happens during a typical session?

A: Each session will vary depending on the patient's diagnosis, but we do follow an overall process.

What to Expect During Aquatic Therapy

At the end of a session, we may add on manual exercises. For example, we (the therapists) might do joint or soft tissue mobilization, which is where we use our hands to gently move your joint to relieve pain, facilitate restoration of movement, and range of motion.

In general, we try to do manual therapy as little as possible. We want you to feel empowered, and able to relieve your pain on your own. Helping you become more independent is one of our primary goals.

Q: How does it work? Why is the water a better setting for some people than land?

A: One of the biggest reasons is unweighting. When you walk on land, your joints bear your whole body weight -- you feel your entire weight with each step. And that can be very painful for some people, sometimes to the point where it's too difficult to walk.

In the water, it's a different story. The buoyancy of water -- the force that gives you or objects the ability to float -- helps you exercise without putting too much weight on your legs, spine, or joints. The more you're immersed in water, the less weight it feels like you're carrying. When you're in water that's up to your chest, you're only bearing 25% of your weight. When it's at your neck, it's 10%.

Basically, you feel a lot lighter, and you can move around without bearing the full force of your body weight on your joints.

Q: How can aquatic therapy help prevent falls?

A: A lot of it also has to do with balance and resistance. Many of our patients have difficulty with balance, and they're afraid to walk because they don't want to fall.

The resistance of water slows down body movements. If you fall, it's a much slower fall than on land, and you won't get hurt. We find that many patients who don't like to walk on land are much less fearful in the water.

Slower body movements not only help with balance, but they can also improve motor coordination and posture.

We see a lot of people -- particularly older patients -- who walk hunched over. But with aquatic therapy, they can stand up straight and walk more upright while in the pool, this will often translate into a more upright poster out of the pool as well.

Q: You mentioned that many people who do aquatic therapy have chronic pain conditions, like arthritis. How does aquatic therapy help them?

A: The temperature of the water plays a big role in pain relief. Our pool is at a therapeutic temperature -- 92 degrees -- which relieves tension on your muscles and joints. The warm temperature of the water, combined with the property of buoyancy, allows you to get more range of motion in your joints with less discomfort.

It's also good for resistance training -- exercises we use during physical therapy to build muscle strength and endurance. Aquatic therapy allows you to perform resistance training but with much less wear and tear on your joints and tendons. So people with conditions such as arthritis will have less pain with aquatic based therapy than with traditional land-based physical therapy.

Q: How many sessions are there?

A: In general, the process takes about 4 to 12 weeks, with two sessions per week.

However, it varies for each person. If you're willing to go do exercises on your own, or if there's a community pool program that you can go to, we might discharge you from our program early, after only a few weeks. We want you to be able to schedule therapy in a time frame that's convenient for you. It also depends on your diagnosis, and how much progress you're making.

Q: Is aquatic therapy the same thing as aquatic exercise?

A: No. They're different. Aquatic therapy is a treatment for a specific impairment or injury that is causing problems such as pain, functional limitations, or balance problems. It must be led by a licensed physical therapist or physical therapist assistant. Since it's a medical treatment, it's often covered by insurance.

Aquatic exercise is simply exercise that takes place in water. It's usually used for health and fitness-related goals. Aquatic exercise can be led individually or taught in a group class, and the instructor doesn't need to be licensed. It's usually not covered by insurance.

CCH offers aquatic exercise classes, too. Learn more about the Aquatic Group Exercise Program

Q: How do you guarantee patient safety?

A: Each therapist works with only one or two patients at a time, and we're either right in the water with you, or sitting at the edge of the pool. We also review safety procedures monthly and we work annually with lifeguards.

Ready to learn more or sign up for aquatic therapy? You will need a physician's prescription to get started. Call 610-738-2480 to schedule an appointment at our Fern Hill Medical Campus in West Chester or learn more about the program. Most insurance plans are accepted.


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Chester County Hospital's Health e-Living Blog offers a regular serving of useful health and lifestyle information for the residents of Chester County, PA and the surrounding region.

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