After TKA patient works on single limb stance, using a noodle for mild balance assist. Therapist provides manual support as patient learns to bear weight on involved extremity in aquatic setting. The pool allows us to progress this activity by adding a current of variable speeds, in various directions to challenge the patient. Patients will then ambulate into the current, forward, backward, and sideways to work on gait in multiple directions, challenging balance and stability.

After TKA patient works on single limb stance, using a noodle for mild balance assist. Therapist provides manual support as patient learns to bear weight on involved extremity in aquatic setting. The pool allows us to progress this activity by adding a current of variable speeds, in various directions to challenge the patient. Patients will then ambulate into the current, forward, backward, and sideways to work on gait in multiple directions, challenging balance and stability.

By Dean Hutchinson, MPT

Be part of something big. This idea was behind the decision taken by Strive Physical Therapy, a 12-office physical therapy practice based in Mt Laurel, NJ, to partner with The Fieldhouse in Moorestown, a state-of-the-art, destination-based indoor sports facility and sports science center.

The owners of Strive and its staff members wanted to ensure they created a product that would complement the facility on both the sports and aquatics side. To achieve that goal, the clinic’s stakeholders were tasked with finding a solution to one question: What was needed to assure proper care could be provided to every type of athlete, non-athlete, and every client in-between?

Building the Vision

One element of that solution required assembling a staff capable of addressing the needs of individuals who sought the clinic’s services ranging from elite, Olympic-level athletes to older adults and geriatric clients. The ever-changing field of physical therapy requires highly trained therapists who can treat every possible injury in every demographic. Bearing this in mind, the practice’s executive team knew staffing decisions would be key in acquiring a talent pool that could deliver the objective to provide comprehensive care to a varied clientele. Thus, careful consideration was given in hiring clinical personnel whose qualifications suggested they could help move Strive toward that objective.

To help shape its clinical program into one that offered the greatest benefit to its clientele, the model of physical therapy Strive envisioned included aquatic therapy. Establishing an aquatic program would provide a valuable rehab option and a competitive edge, but building an aquatic facility from the ground up is an expensive proposition. Rather than take on the capital costs of building a pool facility, the practice followed a tack used by other clinics to first test the waters of an aquatics program: they rented space at local pools. Doing so allowed stakeholders to fine-tune the program and evaluate its prospects before taking on a financial burden.

The program ultimately succeeded and became a significant part of the services provided by the clinic. Over time, however, renting pool time and managing the use of off-site pools created difficulties in scheduling, staffing, and logistics. The benefits of having the clinic own its own pool became clear, not only with regard to solving problems associated with off-site pools but in providing more streamlined service to clients. The decision was made to purchase and install a pool at one of Strive’s existing locations. After a period during which several types of pools were evaluated and discussed, the executive team chose to install a pool from Endless Pools, headquartered in Aston, Pa. These modular pools gave Strive maximum flexibility in its own building, which included flexibility in patient care and scheduling, and the training of elite athletes.

The combination of pools, highly skilled physical therapists, and coaches allows the practice’s competitive swimmer population a new avenue to avoid further injury and facilitate safer, faster return to sport. The pools were viewed as a way to extend into an area of athletics the clinic had not been previously able to address.

The combination of pools, highly skilled physical therapists, and coaches allows the practice’s competitive swimmer population a new avenue to avoid further injury and facilitate safer, faster return to sport. The pools were viewed as a way to extend into an area of athletics the clinic had not been previously able to address.

Taking the Plunge

Two pools were purchased as part of a strategy to provide maximum flexibility and variability in what therapists could do with their clients. One of the pools that was purchased was equipped with an underwater treadmill. Because of its gravity-minimized setting, the treadmill allows athlete-clients to return to weight bearing earlier than what would be possible with land-based therapy. Additionally, aquatic therapy staff members can use the pool’s resistance current in conjunction with the treadmill to work on multidirectional stabilization for athletes as well as non-athletes. One of the applications of this equipment is to enable therapists to prepare athlete-clients for a safe return to sport. Likewise, therapists can also use this equipment to prepare geriatric clientele for safe return to work, sport, and community activities.

Endless Pools’ Elite model was the second pool purchased for the aquatic therapy program, and a pool designed for more aggressive therapy. The current in the Elite pool is much faster, and the pool size is slightly larger than the treadmill-equipped pool. Therapists can work on core stabilization, peripheral stabilization using water as a buoyancy assist, or use the current to provide resistance training.

Other manufacturers who provide pools for the physical therapy market include Middletown, Pa-based HydroWorx, which offers a line of in-ground pools and above-ground models with options such as underwater treadmills, resistance jets, and variable-level floors. Fall River, Mass-based SwimEx offers a line of similarly equipped pools for professional use.

Ins and Outs

The warm, soothing environment of therapy pools may be ideal for certain geriatric and orthopedically involved patients. However, mobility impairments may affect members of these populations and make pool entry and exit difficult. For these individuals as well as individuals who use mobility devices, pool lifts can provide access and an increased level of safety for pool entry and exit. Aquatic Access Inc, Louisville, Ky, offers a line of water-powered ADA-approved pool lifts that can be used for in-ground or above-ground pools, and have a capacity of up to 1,000 pounds. SureHands Lift and Care Systems, Pine Island, NY, also provides pool lifts for professional use. Other options for making pool entry and exit easier include handrails, progressive steps, and graduated entries.

Therapist works with a patient s/p right THA with multiple complications postop.  The pool allows work on both legs with varying degrees of intensity given the very different situation each hip presents. Therapist guides PNF patterns to work on full-body flexibility and lower extremity stability and balance.

Therapist works with a patient s/p right THA with multiple complications postop. The pool allows work on both legs with varying degrees of intensity given the very different situation each hip presents. Therapist guides PNF patterns to work on full-body flexibility and lower extremity stability and balance.

Versatility for Sport-Specific Training and Beyond

The variability of current speed, temperature, depth, and direction of exercise, coupled with the versatility of pool exercise accessories, allow Strive therapists to treat any demographic and any athlete who seeks the clinic’s services. Some of the therapeutic activity clinicians have discovered include the use of tennis rackets in the pool to create resisted and assisted swinging both with and against currents. Likewise, therapists have used the pool to create simulated pitching motions that work on core movement patterns among baseball and softball players.

Running athletes of all types can use the treadmill, which allows the workload to be adjusted by turning on the current as the runner works against the flow of water. The ability to alter depth, temperature, speed of treadmill, speed of current, and the direction of activity with and against current allows therapists to manipulate patients in the water in ways not previously possible, and for which patients report seeing day-to-day benefits.

Accessories designed for water-based activity further expand the therapeutic potential of aquatic rehab and invite therapists to use them creatively to develop exercises that are engaging and effective. Strive’s aquatic facility has an array of accessories that includes aqua dumbbells from Akron, Ohio-based Thera-Band and Springfield, Ore-based Aquajogger. Other accessories provided to therapists include swim paddles from Finis and Speedo and resistance gloves from swimoutlet.com, kickboards from Speedo, and noodles from Target.

Product Resources

Pools, spas, and accessories for water-based rehabilitation are available from these manufacturers:

Aquatic Access Inc
www.aquaticaccess.com

HydroWorx
www.hydroworx.com

Nespa Tiled Spas
www.tiledspas.com

NZ Manufacturing
https://nzcordz.com

Sprint Aquatics
www.sprintaquatics.com

Sure Hands Lift and Care Systems
www.surehands.com

SPRI Products
www.spri.com

SwimEx
www.swimex.com

Hiding in Plain Sight: Swimmers

The flexibility of owning a multifunctional pool has also allowed the clinic to set up a schedule of use that would not have been possible under a rental agreement. The pools were viewed as a way to extend into an area of athletics that the clinic had not been previously able to address. Specifically, the pools offered an entry to provide services to the population of competitive swimming. South New Jersey is an area of the country where swimming as a sport and the numbers of competitive swimmers are found in relatively great numbers. Swimmers differ from the running population in that, as physical therapists, we evaluate runners by putting them on a treadmill and assessing their gait. As a result, the runners improve and are happy.

In contrast, swimmers, who are a significant portion of our clientele, cannot be assessed in their competitive environment using only dry land methods. The new pools solve that problem by providing an actual aquatic environment. Swimmers are evaluated by a physical therapist with expertise in swimming, and the pools provide the ideal medium for this evaluation. The combination of the pools and the highly skilled physical therapists and coaches allows the practice’s competitive swimming population a new avenue to avoid further injury and facilitate a safer, faster return to sport than what was previously provided. This provided the cornerstone on which the Strive Swim Science Center was built.

Strive partnered with the Strive Swim Science Center to cater to the competitive and non-competitive swimmer. Through the partnership, therapists can safely rehabilitate swimmers on land then subsequently address mechanical issues with their strokes that led to injury. The facility also has something to offer healthy, competitive swimmers. For example, training is provided to competitive swimmers in the Elite pool from age-group swimmers to Olympic hopefuls and college athletes, all while patients are participating in rehabilitation in the performance pool. Additionally, the practice offers a Learn to Swim program that is growing in popularity and teaches essential swimming skills to both children and adult members of the community. With drowning still a leading cause of death among young people, the two pools enable the practice to address this important need among the community.

Reaching a Goal and Every Client in-Between

Making the move to purchase and install two pools in a large sports training facility open 7 days a week significantly expanded the potential of the business model for this practice. As a result, clients have access to both land and aquatic therapy on an expanded and flexible schedule that is matched by the flexibility in treatment parameters therapists can use to maximize functional outcomes for our patients, be it high-level Olympic athletes, weekend warriors, or grandmothers and grandfathers. This addition helped the practice move toward its objective when it joined the Field House 2 years ago, and was pivotal in reaching the goal of providing proper care to athletes, non-athletes, and every client in-between. PTP

Dean Hutchinson, MPT, graduated from MCP Hahnemann University in Philadelphia in 1998 and has been a physical therapist for 16 years. Hutchinson is a graduate of one of the nation’s top college swimming teams, Auburn University, where he was a seven-time All American Swimmer. He was also a three-time Olympic trial qualifier and Captain at the World Games, Annapolis, Swim Mac, and other nationally recognized programs. He has worked as a staff physical therapist and clinical director at Dynamic Physical Therapy in Philadelphia, and currently is Aquatics Director at Strive Physical Therapy & Sports Rehabilitation, Mt. Laurel, NJ. Hutchinson is also a partner at the Swim Science Center, Moorestown, NJ. He has a special interest in the mechanics of sport and their role in sports injuries, particularly swimming injuries. For more information, contact PTPEditor@allied360.com.