Chapter 17

Aquatic Physical Therapy

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Physical Properties of Water Buoyancy

Main Controlling Variables:
1. Position or direction of movement in
water
2. Water depth
3. Lever arm length
4. Flotation or weighted equipment use

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Position and Direction of Movement

Movements toward the surface
Buoyancy assisted.
Movements parallel to the bottom of
the pool Buoyancy supported
(gravity minimized).
Movements toward the bottom of
pool Buoyancy resisted.

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Depth, Lever Arm Length, or Buoyant

Equipment Can Alter Resistance
or Assistance
Shallower water Less support.
Deeper water More support, but increased
frontal resistance.
Modifications can be made through use of
buoyant equipment.
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Buoyancy and Lever Arm

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Buoyancy and Flotation

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Resistance Is Influenced By:

1. Velocity of movement (mean muscle
activity alters when velocity reaches
a threshold (See Table 17-1)
2. Surface area
3. Water depth
4. Direction of movement

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Physiologic Changes with Immersion

(Changes vary with immersion depth)
1. Decreased peripheral blood flow, vital
capacity.
2. Increased heart volume, intrapulmonary
blood volume, right atrial pressure, left
ventricular end-diastolic volume, stroke
volume, cardiac output.
3. Decreased or unchanged heart rate.

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Physiologic Response to Exercise

and Immersion
Physiologic adaptations are
similar to land training.
Increased cardiac loading due to
hydrostatic pressure.
Depth of immersion affects
degree of cardiac changes.
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Examination and Evaluation for Aquatic

Rehabilitation
Full land-based examination must be performed.
Also consider:

Basic safety (ability to enter water, comfort, etc.)

Precautions (cardiac history, etc.)
Contraindications to aquatic environment (fever,
infections, rashes, etc.)

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Therapeutic Exercise Intervention

Mobility Impairment
Progress simple ROM exercises toward
functional limitations.
Use lever arm length and buoyant equipment to
alter resistance.
Observe land mechanics before pool exercise to
ensure proper technique.

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ROM
(Hamstrings and Shoulder Extensors)

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Muscle Strength/Power/
Endurance Impairment
Principles and progressions are the same as on
land.
Resistance is influenced by surface area (SA)
and direction. Consider gloves, etc. to increase
SA.
Be aware of groups providing stability.
Leg and trunk stabilizers are necessary to
counter many upper extremity movements.

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Balance Impairment
Ideal environment for balance training.
Variety of activities can be performed.
Loss of balance is slowed dramatically.
Allows for increased reaction time.

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Aquatic Therapy to Improve Balance

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Aquatic Rehab to Treat Functional

Limitations
As patient improves, modify activities to
address functional limitations.
E.g., decrease level of water as sitting
activities improve.
As normal mechanics improve, decrease
water levels to replicate land-based
environments.

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Land-Based Functional Activities in

Water

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Contraindications/Precautions
Individuals with
excessive fear
Open wounds
Rashes
Active infections
Incontinence
Tracheostomy

CV changes
Diuresis
Overexercise

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Summary
Pool provides a unique environment for
rehabilitation.
The properties aquatic therapy provides
can be used in many ways to achieve
therapeutic goals.
Physiologic responses, temperature, and
hydrostatic pressure must be considered for
safety.

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Summary (cont.)
Aquatic therapy can accommodate activities and
progress from early-functional stages.
Balance is challenged with most movements
and stabilizing muscles must be considered.
Pool program should include a land-based
program for a well-balanced transition to the
land environment.

Copyright 2005 Lippincott Williams & Wilkins