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Aquatic Physical Therapy:
Why Have Your Patients Do it?

Jessica Gumm, PT, DPT, ATC
Ai-Chi Certified Aquatic Therapist

What is Ai Chi?

Ai Chi is a water exercise and relaxation program that is performed standing in shoulder depth water using a combination of deep breathing and slow, broad movements of arms, legs, and torso. It was created by combining Tai-Chi concepts with Shiatsu and Watsu techniques.

What are the benefits of Aquatic Therapy?

  • Focus is on long axis of body, which promotes proper posture.
  • Teaches breathing techniques that assist with relaxation and decreasing stress.
  • Movement in water increases circulation.
  • Current and resistance of water increase balance and coordination.
  • Resistance of water increases muscle strength and core stability.
  • Movement increases flexibility and assists with general mobility.
  • Water decreases fear of falling.

Who benefits from Aquatic Therapy?

  • Chronic disorders requiring pain management, such as fibromyalgia, arthritis, MS.
  • Respiratory disorders, such as COPD and asthma.
  • Musculoskeletal or orthopedic problems, including post-surgical, LBP, etc.
  • Neurological disturbances including, CVA, Parkinson's and spinal cord injury (SCI).
Research Supporting Aquatic Exercise

Knee/Hip Osteoarthritis
  • Luciana et al, found water exercise reduced pain on VAS. Water exercise had a greater decrease in pain than land-based exercise group before and after 50 feet walk test and at 18 week follow up. Patients also had a 50% reduction in use of sodium diclofenac.
  • Batterham et al, found outcomes following aquatic exercise in adults with arthritis to be comparable to land based exercise. This shows individuals who are unable to exercise on land may find aquatic therapy be an alternative treatment.
Balance Deficiency and Postural Abnormalities
  • Douris et al, found water allows more upright postures due to an increase in afferent stimulation. Water decreases speed of falling, which decreases fear and allows individuals more time to detect postural errors that may lead to a fall.
  • Katsura et al, found aquatic therapy to improve plantar flexion muscle strength, timed up and go test (TUG), and improved times with 10-m obstacle walking and 5-m maximum walking speed. Patients also reported subjective improvements with difficulty maintaining posture, and decreased tension and anxiety with ADLs.
  • Resende et al, found hydrotherapy promoted significant increases in elderly women's balance, as assessed using Berg Balance Scale and Timed UP and Go test.
Osteoporosis
  • Goldstein et al, found those that exercised in the water 3x/week had greater increases in bone density than a land group. Measurements were performed at the distal radius using Compton Scattering Technique.
  • Takahara et al found that bone mineral density of lumbar spine in women who were "veterans" to water exercise was significantly higher than "newcomers".
  • Ay et al found aquatic exercise to be effective to make an anabolic effect on the bone of postmenopausal, sedentary women when comparing heel bone scans.
  • Rostein et al, found trend towards maintenance or improvement of bone status in the experimental group (aquatic exercise group) and trend towards declining bone status for the control group (no exercise intervention) when comparing DEXA test findings for femoral neck density.
Low Back Pain
  • Ariyoshi et al, found that 90% patients who performed water exercise 2x/week or more had improvements in low back pain and low back disability survey after 6 months.

Who Else Benefits From Aquatic Therapy?

  • Post-surgical or post-trauma: Those who have been NWB or had a lower extremity injury benefit from learning gait training in the water, where water's principles decrease loading on the joint and increase proprioception.
  • Chronic Pain: Water relaxes patients and decreases stress on the body, helping to reduce pain.
  • Inability to Perform Land-based Exercise: Many people are unable to tolerate land-based exercise due to gravity and increased force on joints. Water, when submerged up to ASIS, allows 54% reduction in weight bearing.
  • Shoulder and Neck Injuries: When supine in the water, joints are submerged allowing decrease in swelling and again eliminating gravity, which assists in increasing ROM and decreasing pain.
  • Spinal Pain or Radiculopathy: Anyone with pain in cervical, thoracic, or lumbar spine benefits from decrease stress on joints and decrease pressure on nerve impingement.

Resources

  • Ay A, Yurtkuran M. Evaluation of Hormonal Response and Ultrasonic Changes in the Heel Bone by Aquatic Exercise in Sedentary Postmenopausal Women. American Journal of Physical Medicine & Rehabilitation. 2003. 82(12):942-949.
  • Batterham S, Heywood S, et al. BMC. Systematic review and meta-analysis comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility, and other health outcomes. Muscloskeletal Disorders. 2011 Jun 2; 12(1):123.
  • Douris P, Southard V, et al. The Effect of Land and Aquatic Exercise on Balance Scores in Older Adults. Journal of Geriatric Physical Therapy. 2003; 26(1):3-6.
  • Goldstein E, Simkin A, et al. Wingate Institute. 2004.
  • Katsura Y, Yoshikawa T, et al. Effects of aquatic exercise training using water-resistance equipment in elderly. Eur J Appl Physiol. 2010 Mar; 108(5):957-964.
  • Resende SM, Rassi CM, et al. Effects of hydrotherapy in balance and prevention of falls among elderly women. Rev Bras Fisioter. 2008; 12(1):57-63.
  • Rostein A, Harush M, et al. The effect of a water exercise program on bone density of postmenopausal women. J Sports Med Phy Fitness. 2008 Sept; 48(3):352-359.
  • Silva L, Valim V, et al. Hydrotherapy Versus Conventional Land-Based Exercise for the Management of Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial. Physical Therapy. 2008; 88(1):12-21.
  • Taskahara N, Toda A, et al. Journal of Nutritional Science and Vitaminology. 2004. 2(1).

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