1 Aquatic Therapy 101 Revamped

Aquatic Therapy 101: History,
Properties, and Indications

(Boring but important)
Jaeson Kawadler DPT, CSCS

Who Am I?
Jaeson Kawadler DPT, CSCS
• SwimEx Educator and Consultant

• Senior Physical Therapist at BWH
• MGH Sports Performance Center
Objectives
• Review the history of aquatic therapy
• Review the properties of water
• Discuss the contraindications and indications
of using aquatic therapy
Ancient Roots for Aquatic Therapy
• Healing waters: Greek, Hebrew, Persian,
Roman, Christian and Islamic cultures
• Thermal Baths: Mesopotamia, Egypt, India
and China
• Spas: means “to pour forth” and is found in
most cultures
Bathing in America
• Passive until about 1924 when FDR did
rehabilitation at Warm Springs, GA for his polio
• WWII- some of the best spas were
commandeered for military hospitals for PT and
rehab of those wounded by war
• 1950’s – polio epidemic caused an upsurge in spas
but the Salk vaccine in the ‘60’s caused a decline
Bathing Turns to Rehab and Conditioning
• 1960-70’s – water is used to research the

effects of weightlessness and to help
astronauts prepare for space flights
• 1969 – As Neil Armstrong landed on the
moon, the first issue of “Medical Hydrology
Quarterly” was published to promote the use
of water in a variety of rehab settings
Halliwick Concept
• Developed in London in 1950
• Worked with a group of
disabled young females
• Used a Ten Point Program to
increase the level of function
and independence
Bad Ragaz Ring Method
• A means of strengthening and mobilizing
resistance by the use of PNF, developed in
1967
• Based on the fact that every action has an
equal and opposite reaction
o L hip flexion caused pelvis to drop and R hip
extension
WATSU
• Shiatsu in the water
• Causes very deep
relaxation physically and
emotionally
• Heart and respiratory
rates drop dramatically
• Muscle spasm is relieved
• ROM is usually increased
as a result
Ai Chi
• Aquatic Tai Chi and Qi Gong
• A series of continuous slow
and broad movements
accomplished without force
• Patterns for entire body
• Gradually narrow the base of
support
• Promotes deep breathing
Other Examples
• Water Aerobics
• Zumba
• Pregnancy and Birth
• Etc…
Physics: Welcome back!
• Buoyancy
• Hydrostatic pressure
– Cardiac and pulmonary effects
• Viscosity
• Drag
• Laminar Flow
• Relative Density
• Thermodynamics
• Hot and cold
Properties of Water
• 500-800x more supportive than
air
• Up to 15x more resistant
Making the most of the water!
• Resistance from all three

planes
• Helps make activities more
functional!
Buoyancy
DEF: an upward force exerted by a liquid that opposes the weight of an
immersed object (Archimedes’ Principle)
– aka: force acting in the opposite direction of gravity
– Felt as an upward thrust
• Fat floats
• Muscle sinks
Three Uses of Buoyancy
1. Buoyancy Assisted
2. Buoyancy Supported
3. Buoyancy Resistive
Three Uses of Buoyancy
Buoyancy Assisted: Water assists the motion
-Any motion going toward the surface
ex: standing SLR, assists hip flexors and quads
Buoyancy
Buoyancy Supported: Water supports the
motion (arm on KB and perform horizontal
ABD/ADD or IR/ER)
Buoyancy
Buoyancy Resistive: Water is resisting motion
• foot is on KB, slowly perform hip and knee
extension
• Any movement that deeper or down into the
water!
Buoyancy Benefits
• Decreases:
– weight bearing, joint compressive forces, stress on
connective tissue, fear of falling (balance deficits),
blood pooling
• Supports:
– Weak muscles, enhances flexibility and ROM, changes
biomechanical stress, strengthens muscles working in
opposition to buoyancy, increases ease of handling,
immersion increases O2 delivery
• No movement is necessary!
Relative Density
• DEF: ratio of the mass of an object to the mass of an
equal volume of water
• RD of water is 1.0
• Less than 1.0 floats
• Greater than 1.0 sinks
• Flaccid, edematous extremities, low tone = <1.0
(float)
• Spastic, muscle = >1.0 (sink)
Hydrostatic Pressure
DEF: Pressure of the molecules of a fluid upon an
immersed body
• Pressure increases with depth
• Benefits:
– Decrease pain and edema = inc ROM
– Inc venous return and circulation
• Assists heart pump
– Evens tactile input, turns down reticular system
– Inspiration/exhalation
– Retards muscle atrophy
Cardiac Effects
Immersed up to your neck:
• 700cc’s of blood is displaced
from the extremities and
abdominal vessels into the
thorax and heart
• Causes an increase in stroke
volume and cardiac output so
the heart rate DECREASES
approximately 11-15 bpm
Pulmonary Effects
Increased resistance for
respiratory musculature:
• Circulation shifts from
peripheral to central chest
cavity = Cardiac Output
• Decrease in lung expansion
due to water pressure
• 60% increase in work of
breathing when in neck
deep
Viscosity
DEF: friction between the molecules of a
liquid which cause the molecules to
adhere to each other and to the surface
of the body moving through it
• Provides resistance to movement

• Dependent upon speed and surface area
• Ex. Water vs. Honey
Fun fact:
• When immediately exiting H2O one
carries ONE gallon on your body!! (so
drip dry at the top of the stairs to save
water!!!)
Drag
DEF: Resistance of an object

moving through the water
• Variety of equipment to
increase/decrease this
• Angle of body to laminar
flow can be used to
increase or decrease
drag
Laminar Flow
• Laminar Flow:
– Molecules moving parallel in a continuous steady
movement (stream line flow)
• Turbulent Flow:
– Irregular/random movement of water around a fixed point
– Difficult to measure
– Eddies, tail suction
Resistance
• Benefits:
– Resistance to movements:
• Tone
• Muscle balance
• Cardiac
Thermodynamics of Water
• Heat capacity is 1000x that of air
• Transfer of heat is 25X faster than air
• These facts help achieve desired therapeutic
effects
Temperature
92-95 degrees= Therapy
80-82 degrees=Conditioning
Hot and Cold Plunge Pools
Cold plunge pools:
• 50-60F/10-16C
• Stimulates circulation
• Analgesic effects
• Decreases inflammation
• Increases cytokines
which strengthens the
immune system
• Detoxifies the pores
Hot plunge pools:
• 92-102F/33-39C
• Decreases pain
• Analgesic effect
• Relaxation
• Decrease in blood
pressure
• Decreased stress
Contraindications
• Cardiac failure or • Infections
unstable cardiac • Open wounds/incisions
conditions with no protection
• Urinary infection • Bandages or oozing
• Incontinence • Diarrhea
• Infectious diseases
• Uncontrolled seizures
• Skin conditions
• Fever
Precautions
• Confusion/Disorientation • Surgical incisions and
• Certain Medications open wounds with
• Respiratory Problems protective bandages, no
(Lung capacity 1.5L or less) oozing
• Hypertension • Tracheostomy
• Fearful of water • Impaired peripheral
Sensation
• Cardiac conditions
• Diabetes
• Seizure Disorder
• Vestibular Disorders
• Visual compromise
Indications
• Swelling and peripheral edema movement patterns
• Difficulty or pain with • Dec. in conditioning level
movement on land • Difficulty with heat dissipation
• Decrease in ROM or mobility on land
• Dec. in strength and power • Lack of progress with
• Dec. in balance, traditional land program or
proprioception and/or land makes symptoms worse
coordination
• Weight bearing restrictions on
land
• Gait deviations or poor
Thank You
Citations
• Becker BE, Cole AJ. Comprehensive Aquatic
Therapy. 3rd ed. Pullman, WA: Washington
State University; 2010

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Aquatic Therapy 101: History,

Properties, and Indications

Jaeson Kawadler DPT, CSCS

• SwimEx Educator and Consultant

• 1960-70’s – water is used to research the

• Resistance from all three

• Provides resistance to movement

• Ex. Water vs. Honey

DEF: Resistance of an object

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