AQUATIC

THERAPY By
Dr Rahul Chhatlani
MPT Neuro
Assistant Professor
School of Physiotherapy
P P Savani Univerity
 Learning
2
Objectives
 Aquatic exercise is to
facilitate functional
recovery by providing
an environment that
augments a patient’s
and/or
practitioner’s
ability to perform
various therapeutic
interventions
Therapeutic Exercise- Colby and Kisner,
Thearpeutic exercise - Bandy and Sanders
 Inde
3
x
 Goals and indications for aquatic exercise
 Precautions and contraindications to
aquatic exercise
 Properties of water
 Aquatic temperature and therapeutic
exercise
 Special equipment for aquatic exercise
 Exercise interventions using an aquatic
environment
Therapeutic Exercise- Colby and Kisner,
Thearpeutic exercise - Bandy and Sanders
 Goals and
4
indications
 Facilitate range of motion (ROM) exercise
 Initiate resistance training
 Facilitate weight-bearing activities
 Enhance delivery of manual techniques
 Provide three-dimensional access to the patient
 Facilitate cardiovascular exercise
 Initiate functional activity replication
 Minimize risk of injury or re-injury during
rehabilitation
 Enhance patient relaxation
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Thearpeutic exercise - Bandy and Sanders
 Precaution
5
s
 Fear of Water
 Neurological Disorders
 Seizures
 Cardiac Dysfunction
 Small Open Wounds and
Lines

Therapeutic Exercise- Colby and Kisner,

Thearpeutic exercise - Bandy and Sanders
 Contraindicatio
6


ns
Incipient cardiac failure and unstable angina. Respiratory dysfunction;
vital capacity of less than 1 liter.
 Severe peripheral vascular disease. Danger of bleeding or hemorrhage.
 Severe kidney disease: Patients are unable to adjust to fluid loss
during immersion.
 Open wounds, colostomy, and skin infections such as tinea pedis
and ringworm.
 Uncontrolled bowel or bladder: Bowel accidents require pool
evacuation,
chemical treatment, and possibly drainage.
 Water and airborne infections or diseases: Examples include
influenza, gastrointestinal infections, typhoid, cholera, and
poliomyelitis.
 Uncontrolled seizures: They create a safety issue for both clinician
and
patient if immediate removal from the pool is necessary.
Therapeutic Exercise- Colby and Kisner,
Thearpeutic exercise - Bandy and Sanders
 Properties of water
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 Buoyancy
 Buoyancy provides the patient with relative weightless-
ness and joint unloading, allowing performance of active
motion with increased ease.
 Buoyancy allows the practitioner three-dimensional access
to the patient
 Hydrostatic Pressure
 Increased pressure reduces or limits effusion, assists
venous return, induces bradycardia, and centralizes
peripheral blood flow.
 The proportionality of depth and pressure allows patients to
perform exercise more easily when closer to the surface.

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Thearpeutic exercise - Bandy and Sanders
  Viscosit
8
y
 Water’s viscosity creates resistance with all
active movements.
 A shorter lever arm results in increased resistance.
During manual resistance exercises stabilizing an
extremity proximally require the patient to perform
more work
 Increasing the surface area moving through water
increases resistance.
 Surface Tension
 An extremity that moves through the surface performs
more work than if kept under water.
 Using equipment at the surface of the water increases the
resistance
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 Drag. The cumulative effects of turbulence and

fluid viscosity acting on an object in motion.
 As the speed of movement through water
increases, resistance to motion increases.
 Moving water past the patient requires the patient to
work harder to maintain his/her position in pool.
 Application of equipment (glove/paddle/boot)
increases drag and resistance as the patient moves the
extremity through water.

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 Center of Buoyancy
 In the vertical position, the human center is located
at the sternum.
 In the vertical position, posteriorly placed
buoyancy devices cause the patient to lean
forward; anterior buoyancy causes the patient to
lean back.
 During unilateral manual resistance exercises the
patient revolves around the practitioner in a
circular motion.
Therapeutic Exercise- Colby and Kisner,
Thearpeutic exercise - Bandy and Sanders
 Aquatic temperature and therapeutic
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exercise
 Water conducts temperature 25 times faster than
air more if the patient is moving through the
water and molecules are forced past the patient
 Mobility and Functional Control Exercise
 Temperatures between 26 C and 33 C.
 Beneficial for patients with acute painful
musculoskeletal injuries because of the effects of
relaxation, elevated pain threshold, and decreased
muscle spasm

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 Aerobic Conditioning
 Temperatures between 26 C and 28 C
 Maximizes exercise efficiency, increases stroke
volume, and decreases heart rate
 Intense aerobic training- temperatures between 22 C
and 26 C to minimize the risk of heat illness.

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 Special equipment for aquatic
13 exercise
 Aquatic equipment is used to provide buoyant
support to the body or an extremity, challenge or
assist balance, and generate resistance to
movement. By adding or removing equipment,
the practitioner can progress exercise intensity.

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Cervical Collar Flotation Ring

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Buoyancy belts Swim bars

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Hand paddles Fins and Boots

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Kick Box

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 Exercise interventions using an aquatic
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environment
 STRETCHING EXERCISES
 Patients may tolerate immersed stretching exercises
better than land stretching because of the effects of
relaxation, soft tissue warming, and ease of
positioning. However, buoyancy creates an inherently
less stable environment than the land.
 Manual stretching is typically performed with the
patient supine in waist depth water with buoyancy
devices at the neck, waist, and feet. Alternatively,
the patient may be seated on steps.

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Cervical lateral flexion Shoulder flexion

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
Self-stretching can be performed in either waist-depth or
deep water. The patient frequently utilizes the edge of the pool
for stabilization in both waist-depth and deep water.
 Hip flexion

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 STRENGTHENING EXERCISES
 By reducing joint compression, providing three-
dimensional resistance, and dampening perceived pain,
immersed strengthening exercises may be safely
initiated earlier in the rehabilitation program than
traditional land strengthening exercises

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 Manual Resistance
Exercises:
 Application of aquatic manual resistance exercises for
the extremities typically occurs in a concentric, closed-
chain fashion. 5,

 Manual aquatic resistance exercises are designed to fixate

the distal segment of the extremity as the patient contracts
the designated muscle group(s).

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Shoulder flexion Hip Abduction

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Dynamic trunk stabilization

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Independent Strengthening Exercises

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 AEROBIC CONDITIONING
 Aerobic/cardiovascular exercise typically takes place
with the patient suspended vertically in deep water
pools without the feet touching the pool bottom.
Alternative activities that may be performed in mid-
level water, 4 to 6 feet in depth, include jogging,
swimming strokes, immersed cycling, and
immersed treadmill

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 Physiological Response to Deep-

Water Walking/Running
 Cardiovascular Response
 Patients without cardiovascular compromise may
experience dampened elevation of heart rate,
ventilation, and VO2max compared to similar
land- based exercise.
 During low-intensity exercise, cardiac patients
may experience lower cardiovascular stresses.
 As exercise intensity increases, cardiovascular
stresses approach those of related exercise on land
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 Exercise Monitoring
 Rate of perceived exertion
 Heart rate
 Careful monitoring for
beginners

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