Water Fitness

Pattern Treatments
Aquatic PNF offers another take on resistance therapy
By Andrea Salzman, PT

These two poses show the starting and

ending positions for the upper extremity movement pattern of PNF
D1 using water bells.
 Here, the illustration shows the beginning and
ending positions for upper extremity movement pattern of PNF D2,
again using water bells.
ADDITIONAL RESOURCES
Aquatic Therapy Using PNF Patterns by L. Jamison and D. Ogden
(Therapy Skill Builders, San Antonio, 1994). Original Aquatic PNF
text; currently out of print.
www.aquafit.com

Online Web site, which includes information about books, videos and
training in Aquatic PNF.

www.aquaticnet.com/ai.htm

Online clearinghouse of aquatic therapy information for Aquatics

International readers. Includes the latest research on Aquatic PNF,
Ai Chi, Watsu and other aquatic techniques.

In the early 1950s, physicians and therapists were scrambling to find

treatments that might work for a new crop of polio patients.
Dr.Herman Kabat first developed a technique called proprioceptive
facilitation to address the paralysis caused by this dreaded disease.
(Neuromuscular was added to the name in 1954.)

Within a decade, Kabats PNF spiral and diagonal movement

patterns were modified and exported to Bad Ragaz, Switzerland,
where they further morphed into an aquatic specialty technique
known today as the Bad Ragaz Ring Method (see Aquatics
International, February 2008 issue, for more on Bad Ragaz).
In this new Ring Method, clients were trained to perform spiral and
diagonal movements while a therapist provided a fixed external
resistance. The patterns were performed horizontally, making use of
the concept of a floating treatment table.

However, all PNF did not transform into Bad Ragaz patterns. Many
aquatic providers continued to experiment with traditional PNF
patterns (D1/D2 flexion and extension) without providing a fixed
distal resistance. These movements were performed in all positions,
including horizontal, standing, sitting, kneeling and quadrupedal.

Over time, these traditional-looking PNF patterns became known

simply as Aquatic PNF.

In 1993, Lynette Jamison and David Ogden co-wrote Aquatic Therapy

Using PNF Patterns, the first widely published book on the use of
PNF patterns in the aquatic environment.

Aquatic PNF can be performed in any water temperature, though

most therapy pools are kept above 89- to 90 degrees Fahrenheit.

In the Bad Ragaz Ring Method, the patient floats horizontally on the
pool surface while the therapist stands as a fixed point of contact.
In contrast, in the Aquatic PNF, the therapist typically relies on
external forces (such as gloves or a dumbbell) to provide resistance
or drag to a moving distal part.
In Aquatic PNF, the client is verbally, visually and/or tactilely
instructed in a series of functional, spiral mass movement patterns.
The patterns may be performed actively or with assistance or
resistance provided by equipment or the therapist.

Todays clinicians no longer have to haul out the recycled bleach

bottles and awkward kickboards to get the workout they desire for
their clients. Instead, they can incorporate specially designed
aquatic gloves, paddles or bells into upper extremity patterns.
Therapists use such equipment during PNF to increase drag
andfrontal surface area, or to decrease streamlining.

Resistance devices for the lower extremities have come a long way
as well; options now include fins, boots or specially designed
aquatic resistance shoes. Therapists who wish to perform PNF in
the horizontal position typically also use flotation devices to create
a floating plinth.

Therapeutic pools with water depths of 31/2 feet to 5 feet work best
for clinicians wanting to provide Aquatic PNF. Therapists with
shallower pools (such as 2 feet to 31/2 feet) can make use of
alternative workouts for their clients. For instance, at such depths,
quadrupedal and kneeling become viable treatment positions. Quiet
acoustics are not necessary for Aquatic PNF, though the
environment should allow clients to hear the therapist without
difficulty.

All health-care providers may integrate Aquatic PNF techniques as

they are learned. No aquatic-specific PNF certifications are
available, but there are certainly plenty of land-based options.