(Photo above) The most common treatments used with aquatics is for rehabilitation of the athlete. This population needs to be challenged by exercises performed in the pool. One way to meet that objective is through the use of pool accessories that can help put maximal load on tissues during exercises and activity.

By Vicki Buchanan, PT

Entering the gym area of the clinic at Regional Physical Therapy, Midwest City, Okla, you can smell the pool. The smell of summer permeates the clinic year round in the form of the bromine chemical. Patients love the pool therapy treatments, and we often have a waiting list to get into our pool. Having aquatics on-site is a benefit that most clinics don’t have available for their patients, but it is one that clinic managers should consider heavily. Pools are a luxury treatment option and, as such, they are appreciated by most of our referral doctors. Not all pools are created equal.

Pool Performance Assessment

Pools that allow resistive current for exercise will give the therapist much greater ability to treat a wider variety of conditions. There are a couple of resistive pools that fit nicely into a compact space. Swim-Ex, Fall River, Mass, manufactures a popular brand of therapeutic pool that has many advantages, including the ability to adjust the pool depth, allowing for a variety of diagnosis to be treated. Another manufacturer, Endless Pools, Aston, Pa, has resisted current, allowing for resisted training as an added benefit to the standard aquatic benefits. An additional provider is HydroWorx, Middletown, Pa, which offers pools designed to provide benefits to the PT clinic such as an underwater treadmill that can expand the utility of the limited space inside a pool.

The limiting factors of a pool are length and depth, so pools that allow a clinic to vary those dimensions with a removable floor or resisted forward motion with water flow greatly expands the uses of the pool. For clinics that may be considering installing a pool, before making a final purchase decision it is wise to visit facilities that have existing pools to observe how they are used. While visiting the site, be sure to evaluate the pool’s form, function, and features. It is advisable to conduct these on-site evaluations of pools from several different manufacturers before making a final decision. Remember to ask about maintenance support for the motor, filtration system, and heater.

[sidebar float = “right” width = “250”]Product Resources

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

Aquatic Access Inc


Nespa Tiled Spas

NZ Manufacturing

Sprint Aquatics

Sure Hands Lift and Care Systems

SPRI Products


Entry, Exit, and Safety

Aquatic therapy, while initially expensive to operate, is a wonderful treatment option for many patients who otherwise couldn’t tolerate physical therapy intervention. The pool at this facility is installed so that there are 18 inches above the ground to allow patients to enter the pool by sitting on the side and turning to step down onto a small step to enter the pool. For those who can’t enter at the side, the facility has installed a chair lift. A lift chair is a great addition to any pool that allows patients with weaknesses to get in and out of the pool easily, and keeps the practice in compliance with the Americans with Disabilities Act (ADA). When shopping for this important piece of equipment, it is advisable to consider a lift that will accommodate bariatric patients. Doing so will expand the clinic’s population of clientele who can easily use aquatic therapy.

Many good brands of pool lifts are available to the physical therapy market, including those from manufacturers such as Global lift, Bad Axe, Mich; Aqua Creek, Missoula, Mont; Aquatic Access, Louisville, Ky; and Spectrum Aquatics, Missoula, Mont. Each of these companies offers high-quality chairs built with a variety of options and available in a range of prices. Aquatic Access, for example, offers lifts for in-ground or above-ground pools as well as custom lifts. The company’s Pool Lift IGAT-180 is powered by water pressure, which eliminates the use of batteries and provides “green” operation. The IGAT-180 footrest flips up to make transfer easier, and the seat rotates forward to enter the pool and backward to exit. For this particular outpatient clinic it was determined that an anchored chair works best, allowing greater stability during the transfer into the pool. Other models, however, have mobile options that allow clinic staff to move them out of the way if space is an issue. Likewise, Spectrum Products offers a line of pool lifts that operate on battery power or water power as well as portable models and platform lifts.

Accessories Expand the Options

Aquatic therapy has been beneficial for many of our patients and we have expanded the conditions treated with pool therapy. Initially, we treated a fair number of patients with lower back pain who had not responded to physical therapy with land-based exercises. Various floatation assistance equipment such as pool noodles, water wings, and vests worn in the water can provide assistance to movement patterns that prove more challenging on land. Water wings can be used with adults on the arms to provide more or less assistance for shoulder exercises, allowing the therapist to progress the patient easily. Also, a good-quality floatation vest is worth the cost as it will last through years of daily use. Several sources provide pool accessories for the PT clinic, including Sprint Aquatics, San Luis Obispo, Calif, which offers a full line of belts, collars, water weights, floats, and the Water Walking Assistant.

Pool therapy can provide a relaxation effect that is successful for relief of many chronic pain conditions. Pain associated with arthritis as well as orthopedic conditions are relieved with the relaxing effects of the water. The use of buoyancy devices for total body relaxation can be achieved by putting the patient in a float vest and then using other floatation items to support the limbs and head. For this reason, vests with a collar can serve as the floatation for the head, keeping the ears out of the water during the relaxation exercises.

Patients with balance challenges do really well in the pool. The one thing I tell them is, “You can’t fall in the water!” They may lose their balance, but they never hit the floor. Balance-challenged patients do well with a group in the water to allow moving currents that will challenge their balance. Swim paddles, Sporti, Speedo, or Strokemaker applied to the hands allow resistance and eddies to strengthen the patient’s ability to overcome sudden instabilities. Progression of difficulty in the exercises can be done with the use of these items in a standard pool that doesn’t have a laminal flow.

Pediatric Aquatic Therapy Patient

The pool allows this patient freedom to move and facilitate rolling from the lower extremities while using the floatation belt to stabilize her trunk. Her first time to roll was in the pool.

Pool Tools for Pediatric Patients

Pediatric patients are one population for whom the practice is expanding the aquatics program. Children love the water, and therefore exercises performed in the pool feel like a play day rather than a therapy session. Likewise, children love the equipment (also known as toys) they get to use in the pool. Recently, a 2-year-old girl diagnosed with lissencephaly (smooth brain syndrome) was treated by therapists at the clinic who used the pool to work on her rolling skills.

The young girl previously had not engaged any trunk muscles to initiate the rolling skill. Once placed in the pool on her back and given small tactile cues through the legs, she began to engage her core and actively rolled to her stomach. The core stimulation quickly translated to land, and she began rolling over at home that week. The weightless environment of the pool, facilitated by floatation devices supporting her head, allowed the minimal strength of the core muscles to become strong enough to roll over.

Working in Water Eases Pain

Severe and chronic pain patients are particularly fond of the pool therapy for both its relaxation and unweighted effects. The use of floatation vests enhance the spinal decompression effects assisting the body to reduce arthritic and compression syndrome pains. The pools with laminal flow options can allow a therapist to perform traction-type treatment for the lower back and legs. Using floatation for the upper trunk combined with the resistance of the water for the lower trunk creates a traction effect that is gentle enough for even the most hyper-painful patient populations. Even compressions in the cervical spine can be helped with the use of floatation vests (and noodles if extra floatation is needed), coupled with the use of weights on the lower extremities to allow distraction forces through the cervical spine. A patient can simply “hang” in the water and reduce the compression through the neck.

[RELATED: Improving Chronic Pain and Limited Mobility With Water-Based Therapy]

Fibromyalgia patients who haven’t responded to any other therapeutic intervention often improve with aquatics. The hydrostatic pressure of the water and the relaxation effects allow the muscles to relax enough to reduce the tension that is created by the overactive connective tissues. Several studies have shown that aquatic therapy intervention focused on endurance, flexibility, and relaxation has shown to improve quality of life. Watsu techniques are particularly helpful for relaxation, using the rhythmical stabilizing motions. The body must be supported at the trunk and all the major joints by floatation devices for full relaxation to be achieved.

The most common treatments used with aquatics is for rehabilitation of the athlete. This population of patients uses completely opposite treatment techniques. These patients need to be challenged by the exercises in the pool. Weighted vests and extremity weights help to put maximal load on the tissues during exercises. During healing phases after injury or surgery, the pool will allow athletes to maintain good conditioning practices. Loading and stressing the soft tissues enhances the stimulation of collagen for the bones and tendons that helps prevent future tissue failure.

The investment in equipment specifically designed for aquatics is worth the cost since they hold up much longer in the water. Equipment and accessories not designed for water will eventually break down and cause pumps to become clogged with the material used for construction of the equipment. Equipment not meant for aquatics can create significant problems in the pool and ultimately result in expensive damage to the pool system. PTP

Vicki Buchanan, PT, is founder and owner of Regional Physical Therapy Inc in Oklahoma. Vicki is a 1986 graduate from the University of Oklahoma Health Sciences Center physical therapy program. She has multiple outpatient clinics and is an active member of the APTA and OPTA. For more information, visit [email protected].

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