Aquatic Therapy is a form a physical therapy which is performed in water, usually in specialist hydrotherapy pools. Aquatic therapy and rehabilitation involves a many treatments, exercises and interventions similar to traditional physical and exercise therapy and manual therapy except its undertaken in water. As a result, all musculoskeletal aches, pains and strains and other more advanced conditions and disabilities can be treated and managed in the pool.
People with pain and disabilities are often caught in a cycle of pain, muscle spasm, pain, stress and depression. Musculoskeletal conditions and disabilities can lead to social isolation and an external locus of control, believing that one has little choice or control over management and treatment of their condition and their future. Hydrotherapy and aquatic rehabilitation can be the key to breaking this cycled due to the unique properties of water enabling treatment and intervention not possible on land.
Some injuries, conditions and disabilities are specially recommended by health and social care organisation, patient groups and published research articles for treatment and management by hydrotherapy and aquatic rehabilitation, these include:
• Arthritis (Osteoarthritis)
• Rheumatoid Arthritis
• Ankylosing Spondylitis
• Multiple Sclerosis
• Stroke and Brain Injury
• M.E (Myalgic Encephalomyelitis)
• Back pain
• Neck pain
• Knee, Hip and Shoulder pain
• Hip and Knee joint Replacement (post-surgery)
• Joint sprains (muscle and tendon injuries)
• Sport Injury rehabilitation
• Shoulder rehabilitation
• Fitness conditioning
• General Sports Fitness and strengthening
• Obesity related pain and disability
Below is a summary list of the benefits of Aquatic Therapy
• Increased mobility
• Reduction or pain and muscle spasm
• Improvement or maintenance of joint motion
• Strengthening of muscles
• Increased physical fitness and ability to exercise
• Regaining normal movement patterns
• Improved balance
• Improved co-ordination
• Improved posture
• Improved self confidence
Hydrotherapy can be a highly effective for the treatment, management and prevention of a wide range of health conditions. However, there are some precautions which must be considered before starting a hydrotherapy and an aquatic rehabilitation programme which will need to be discussed with your healthcare professional, including:
• If you have any open wounds and skin infections.
• Current or recent cold, virus, raised temperature
• Diarrhoea, vomiting - must be at least 48 hours clear
• Angina, cardiac and respiratory conditions
For any further questions or queries on what hydrotherapy can treat and manage send an email to Ben at email@example.com
Links to professional health and disability organisations and charities
Arthritis Research UK
National Ankylosing Spondylitis Society
Fibromyalgia Association UK
Multiple Sclerosis Society
Action for M.E
Healing Waters: How Does Aquatic Therapy Relieve Pain?
Water, more specifically, immersion in water, has been used for the treatment of a wide range of injuries and ailments which has been documented for well over four thousand years. There have been many thoughts and theories as to the mechanism behind the recovery and improvement experienced by people throughout history.
From the notion that water immersion ‘cleanses the body’, purging illnesses and ailments, to the idea that immersion ‘refilled’ health essential ‘humors’ and fluids in the body; these ideas have become far outdated! Over the past two decades research in to the effects of hydrotherapy and aquatic rehabilitation has grown considerably and updated the pain science behind the treatment and hydrotherapy continues to be as important today as it was in the past.
From a physiological and bio-mechanical perspective explaining short-term pain relief though water is relatively straight forwards.
Buoyancy – The weightlessness of water places less pressure on muscles, joints and ligaments so any injured or over pressured tissues or joint surfaces experience fewer painful stimuli
Muscle Relaxation – Warm temperature has a relaxing effect of muscles. The mechanism behind this is suggested to be reduced nerve activity secondary to heat which diminishes the nerve impulses to overactive muscles, easing painful spasm.
Mental Relaxation – Water submersion causes suppression of the sympathetic nervous system. The sympathetic nervous system is part of the autonomic nervous system which regulates the body’s unconscious actions. Over-activation of the sympathetic nervous system primes the body’s ‘flight-or-flight’ response which can place additional stress on the body’s organs leave us feeling stressed. When we are immersed in water there is a dampening of the sympathetic nervous system, which is a large part of the reason for the feeling of relaxation and calm when in the bath, swimming pool or spa.
Natural Analgesic – The ‘Gated Theory of Pain’ suggests that a secondary stimulus following a painful one overwhelms the body’s nerve signals; with too much nerve signal ‘traffic’ to transport we experience fewer pain signals. The greatest example of this is when we hit our knee against the table, we rub it better; the sensory information from rubbing our knee reduces the total pain information from banging our knee reaching the brain’s pain centres, so we experience less pain.
The same is true with temperature sensation. As the body’s nerves detect a change in temperature and report this to the spinal cord and brain, it diverts some traffic from any pain signals from other parts of the body. The result is the inhibition of some pain receptors altering our perception of pain.
Improved Circulation – When we are in warm and hot temperatures the nervous system signals blood vessels, particularly the small blood vessels near the skin’s surface, to open up (vasodilation). This in turn improves blood flow through the body with reduced vascular pressure, where greater increases in circulation are achieved with light-moderate exercise.
The process of vasodilation when immersed in water improves the blood flow to muscles and tendons up to 250% throughout the body and therefore assists in healing muscles tears and other soft tissue injuries.
Reduced Pressure on Cardiovascular System – During water submersion there is an increase in blood flow from the heart (cardiac output), but due to vasodilatation of the blood vessels, there is less resistance in the blood circulatory system so blood pressure decreases. This places less pressure on the cardiovascular system during activity and exercise in water
Reduced Swelling and Odema – Hydrostatic pressure is the force of fluid molecules pushing against your body when you’re submerged in water. People with swelling or odema (particularly in the legs and feet) may have noticeably less swelling during their time in the pool. The reduction in swelling goes beyond visible swelling on the surface where swelling within the joints is also reduced. Reduced joint swelling means that there is less pressure being exerted on tissues surrounding the joint which can be the cause of pain or increase pain on particular movements.
The combination of all these factors is the reason so many people find Aquatic Therapy and Hydrotherapy incredibly relieving for aches, stiffness and pain.
But, what about when you get out of the water!?
That’s one of the limitations with the physiological and biomechanical benefit of being immersed in water; it only lasts while you’re submerged and a short while following!
For long-term reductions in pain, stiffness and disability the key is to take advantage of these benefits while you’re in the water; performing recommended exercises, stretches, swimming and receiving manual therapy from a qualified professional. The aquatic environment enables us to move, tone, strengthen, stretch and balance in ways impossible on land, but develops flexibility, strength, endurance, co-ordination and balance that are directly transferred to supporting our body on land. Combine this with the physiological improvements of reduced swelling, pain and muscle spasm with increased circulation and relaxation results in a highly multi-effective route to short-term pain relief enabling long-term rehabilitation and recovery.
So how does Aquatic Therapy relieve pain long-term?
The role of aquatic rehabilitation and hydrotherapy is to facilitate pain relief so that the benefits of exercise and manual therapy can be maximised during sessions. The aim is to work towards exercise and self-management on land.
This is how aquatic therapy has a long-term impact, it supports people to move through, over, under or around barriers so that they can access the support, tools and knowledge on how to best self-manage and prevent musculoskeletal pains, aches and strains and more advanced conditions and disabilities.
For any further questions or queries on this topic drop an email to Ben at
firstname.lastname@example.org or read through the ‘Benefits & Research’ pages at www.fluid-motion.org.uk
Brederson, J. Kym, P. and Szallasi, A. (2013). Targeting TRP channels for pain relief. European Journal of Pharmacology 716(1-3), pp.61-76. Verrill, 1990
Burnstock, G. (2013). Purinergic mechanisms and pain-An update. European Journal of Pharmacology 716(1-3), pp.24-40.
Campion MR, ed. (1998) Hydrotherapy principles and practice. Butterworth- Heinman, Oxford
Fountain, F. Gerslen, J. and Senger, O. (1960). Decrease in muscle spasm produced by ultrasound, hot packs and IR. Archives of Physical and Medical Rehabilitation (41), pp.293-299. Melzack and Wall, 1965)
Knight, K. and Draper, D. (2013). Therapeutic Modalities: The Art and Science. 2nd ed. Baltimore: Lippincott, Williams & Wilkins.
Mooventhan, A. and Nivethitha, L. (2014) Scienctifiy Evidence-Based Effects of Hydrotherapy on Various Systems of the Body. North American Journal of Medical Science 6(5), pp. 199-209.
Petrofsky, J. Baxter, J. Bomgaars, J. Burgert, C. Jocobs, S. Lynden, D. and Lohman, E. (2003). The Influence of Warm Hydroterhapy on the Cardiovascular System and Muscle Relaxation. Department of Physical Therapy. Loma Linda University.
Reid, R. Foley, J. and Prior, B. (1999). Mild topical heat increases popliteal blood flow as measured by MRI. Medicine & Science in Sports and Exercise 31(5), pp.208.
Sato, D. Yamiashiro, K. Onishi, H. Shimoyama, Y. Yoshida, T. and Maruyama, A. (2012). The effect of water immersion on short-latency somatosensory evoked potentials in human. BMC Neuroscience 13(13).
Pendergast, D. and Lundgren, C. (2009) The underwater environment: cardiopulmonary, thermal, and energetic demands. Journal of Applied Physiology 106(1) pp. 276-283.
....to Juliet Weston who completed the London Marathon in 4 hours and 7 minutes....great time!
Juliet is one of a number of our clients who completed the Marathon - we were delighted to get this "thank you" from her!
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