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Water Fitness

Pattern Treatments
Aquatic PNF offers another take on resistance therapy
Aquatic Therapy In India - blogger640 480Cutai dup imagine

Bad Ragaz Ring method exercises can be divided into patterns for the trunk, arms, and legs.
They can also be categorized as unilateral or bilateral.

By Andrea Salzman, PT

These two poses show the starting and ending

positions for the upper extremity movement pattern of PNF D1 using water
Here, the illustration shows the beginning and
ending positions for upper extremity movement pattern of PNF D2, again using
water bells.
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.

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

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

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

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.