Therapy Summer Series: Aquatic Therapy

Water is not only fun to play with when the outside temperatures soar, but also a great natural motivator and healing tool, which is why aquatic therapy can be so effective. This type of therapy uses water’s unique properties to boost exercise performance without straining the body. It involves:

• Buoyancy: Water’s weight-bearing effect in an aquatic environment supports a range of motion (ROM) exercises that would be more challenging on land.
• Resistance: In water, the increased resistance to movement helps improve muscle strength.
• Therapeutic temperature (80-84 °F): Warm water feels comfortable to the body while soothing post-surgical areas, which are usually hotter (98-101 °F)

Keeping these three properties in mind, let's explore the issues that aquatic therapy targets, the different types of aquatic therapy available, as well as the steps to becoming a certified aquatic therapist.

The History Of Hydrotherapy

Hydrotherapy, commonly known as aquatic therapy, has an ancient history all around the world. For example, ancient Romans and Greeks bathed in hot springs to promote circulation and relaxation. Swiss monks also used it on the sick and disabled members of their community. In Asia, the onsen (Japanese hot springs) were believed to help with pain, skin problems, and menstrual disorders.

In fact, Hippocrates wrote of the healing properties of warm water many times and even proposed the idea that illness could be caused by an imbalance of bodily fluids. This hypothesis sparked a wave of new therapy techniques, from massages and daily walks to saunas and pools being integrated into gymnasiums. While the theory of bodily fluids may not have been wholly accurate, there's no doubt that Hippocrates played a great role in establishing aquatic therapy as it is used today.

What Issues Does Aquatic Therapy Target?

During a water therapy session, a physical therapist focuses on various movements based on the patient's condition and target goals. The purposes of aquatic physical therapy may include (but are not limited to):

• Assisting with gait, balance, and locomotion
• Reducing joint compression and swelling
• Preventing injury

For example, someone with Duchenne Muscular Dystrophy (DMD) or other neurological/neuromuscular disorder may want to build muscle strength, enhance aerobic capacity, and improve balance or coordination. While land-based therapy may prove difficult or even unsafe for someone with DMD, aquatic therapy can help a patient achieve those goals much more easily!

Some other conditions commonly treated by water-based therapy are:

• Post-surgery rehabilitation: One benefit of aquatic therapy is easing patients into exercise as they work on recovery after surgery. The water may also soothe post-surgical areas that are tender and painful.
• Chronic pain/joint pain: With about 80% of a patient’s body weight eliminated when submerged in water up to the chest, they can retrain their joints and muscles in a more soothing setting.
• Obesity: Studies show that water exercise yields promising results for obese patients since the reduced weight allows patients to perform exercises that would be near impossible on land. It also reduces injury risks and can make exercise more enjoyable.

The above list is not exhaustive. Any condition that could use therapy exercise with the help of reduced body weight, hydrostatic pressure, or the soothing nature of warm water may benefit from aquatic therapy. However, there are exceptions where aquatic therapy may not be recommended, such as infections and incontinence (poor bladder control). Others include:

• Cardiac disease
• Uncontrolled seizure disorders
• Chronic Obstructive Pulmonary Disease (COPD)

Requirements/Training To Become An Aquatic Therapist

Varied aquatic therapy certificates exist depending on the technique a physical therapist specializes in. For example, a therapist may obtain an intervention-specific certification focusing on specific techniques, such as Halliwick, Bad Ragaz, Watsu, or others. 

There are also population-specific certifications — like one for arthritic patients available through The Arthritis Foundation Aquatic Program (AFAP). Other workshops and courses include:

• Aquatic Therapy & Rehab Institute (ATRI): provides aquatic therapy training and continuing education courses through conferences and workshops.
• Aquatic Exercise Association (AEA): offers specialized certification courses.
• SHAPE America: awards certificates after completing their Adapted Aquatics Instructor Training (AAI) course.

Additionally, a physical therapist can also obtain a basic aquatic certification, including Water Safety Instructor (WSI) and Lifesaving through humanitarian organizations such as the Red Cross. These aquatic training certifications generally require trainees to understand movement mechanics, water science, pool therapy methods, health and safety, professional responsibilities, as well as legal considerations.

Types Of Aquatic Therapy

There are several distinct types of aquatic therapy that providers may use. A few of the most popular therapy alternatives include:

• Bad Raga Ring Method uses flotation rings to suspend the patient horizontally at 91.4°F, improving their strength as well as mobility.
• Halliwick uses buoyancy to support the trunk’s mobility and core stability while focusing on control of axis rotations.
• Watsu combines shiatsu, massage, stretching, joint metabolism, and dance to increase potential healing on several levels, such as pain, injury, movement, etc.
• Ai Chi borrows from Tai-Chi concepts as well as Shiatsu and Watsu techniques to integrate mental, spiritual, and physical energy into therapy.
• The Burdenko Method integrates land and water approaches to help improve strength, flexibility, coordination, balance, endurance, etc.

Aquatic Therapy In Action

Water-based therapy is more common than one might expect! Many multi-disciplinary therapy and rehab practices offer aquatic therapy options as an extension of their physical therapy services, typically through an external gym or with an on-site saltwater pool. For an idea of what to expect, check out these Raintree clients and the aquatic therapy programs they offer!

• Lucas Therapies
• Ivy Rehab
• Functional Kids 
• Olympic Sports & Spine 

Just like with any other form of treatment, aquatic therapy relies on a strong patient-provider relationship to achieve the best outcomes. With the help of digital healthcare solutions, therapists are able to empower more efficient and engaging care in addition to facilitating automated engagement that results in personalized patient experiences.

Here at Raintree, we pride ourselves on providing the most powerful, flexible software solutions and services to the therapy and rehab market. Our all-in-one platform helps every element of your practice grow, whether it be leveraging data-driven automation, interactive reporting, interoperable billing, or customizable clinical documentation, we simply allow providers and their staff to dedicate more time to delivering quality care to patients in need as well as find a better work-life balance for themselves too.