By Carol Green, PT, COMT
For patients who are affected by injuries or conditions related to the spine, shoulder, hip, knee, or ankle, land-based physical therapy can be augmented by treatment in an aquatic therapy program. In many cases, the healing process can be initiated sooner than normal because of the natural properties of water that allow recovery without weight-bearing or limited weight-bearing. In the pool, the water supports the physical weight of the human body, which utilizes muscle memory to stimulate the recovery process toward full function. As part of the aquatic therapy program at OrthoCarolina, patients who participate in the program are able to exercise in two HydroWorx pools from HydroWorx, Middletown, Pa, that are installed at the facility and equipped with underwater treadmills.
There are many clinical benefits associated with aquatic therapy programs, and therapeutic activity conducted in a water-based environment. Following are four advantages considered significant:
1) The buoyancy of the water reduces the stress and pressure of body weight on joints, discs, ligaments, tendons, muscles, and bones by unweighting the involved or weakened body part.
2) The force of the water provides resistance (much like weights on land) to allow the patient to strengthen the injured area in a more comfortable environment without pain.
3) The pressure of the water decreases edema, improves positional and postural awareness, and balance to reduce fall risk.
4) The warm 90-degree temperature of the water helps reduce muscle spasm, increases circulation, and promotes relaxation.
Patients perform flexibility, range of motion (ROM), strengthening, gait, balance, and conditioning exercises with the aid of floatation devices and aquatic resistance equipment. The HydroWorx underwater treadmill links to a viewing monitor that is invaluable in helping therapists to analyze the patient’s gait and balance. Being on this treadmill in the water allows the patient to more quickly obtain an upright posture, faster speed, and proper gait to prepare for land ambulation. The patient is also able to practice in a more controlled environment forward, backward, and sideward walking with less fall risk.
The adjustable water jets on the side of the pool create a current with additional resistance against which a patient can walk or swim. The jets can also provide a massaging action to reduce muscle spasms and promote circulation. Patients may use the Aquasphere mask for protection of the eyes when swimming against the current for aerobic conditioning.
Other manufacturers who offer above-ground and below-ground pools built especially for aquatic therapy include Aston, Pa-based Endless Pools, which offers its Commercial Series of pools with variable-speed swim current and hydraulically powered underwater treadmill. Nespa Tiled Spas, Oroville, Calif, also supplies products in this category, including a line of standard and custom swimspas designed for a variety of commercial applications.
[sidebar float=”right” width=”250″]Product Resources
The following companies provide products for water-based therapy:
Hydro-Tone Fitness Systems Inc
Nespa Therapy Pools
NZ Manufacturing Inc
SureHands Lift & Care Systems
ACCESSORIES ADD VERSATILITY
For a patient suffering from spine or lower-extremity pain, a floatation device can be put under the body to focus on arm and leg movements with the back in a relaxed position. Balance and gait floatation devices with foam/noodles are shaped to encircle the patient and allow them to maneuver through the water while holding onto the handles.
Patients can perform a biking motion (similar to biking on land) with the legs while being supported. The foam devices and noodles add even more buoyancy, reduce fall risk, and allow easier movement to support the affected body part to prepare for movement on land.
Floatable pool cuff weights for the ankle and wrist made by Sprint Aquatics, San Luis Obispo, Calif, are among the accessories used often at this facility to increase the resistance of the body part while working in the water. The patient can easily don and doff the weights in the pool and progress their strength simulating the use of cuff weights on land. The Predator Aquafins, which look like wings, attach to the ankle or wrist and have a wider surface area to add even more resistance to further advance the patient’s strength. Speedo paddles or bells allow a larger surface area when pushing or pulling with the upper extremity to create more resistance for strengthening. These activities prepare the patient for using pulleys and weights on land, in addition
to exercises that use the Thera-Band and Thera-Band tubing from The Hygienic Corporation, Akron, Ohio.
Kickboards from Sprint Aquatics are used to allow floatation support for various extremity exercises and are also used for core strengthening. The patient can push or pull the kickboard in front of the body while walking through the water, engaging the core muscles against the resistance. The support of the water allows the patient to work on core stabilization in an upright position sooner than on land.
LIFTS FOR POOL ENTRY AND EXIT
A patient who needs assistance into the pool can easily be lifted with the ADA-compliant hydraulic lift chair used in the OrthoCarolina facility. The facility’s chair lift from Aquatic Access, Louisville, Ky, features a chair that is smooth and safe, and equipped with a seat belt, which makes entering and exiting the pool easy and comfortable. Also, if a patient is not strong enough to stand, that person can sit on the lift’s chair and perform arm and leg exercises. The chair lift allows patients at all levels of ability to safely participate in the water therapy program.
The goal of the physician and the physical therapist is to rehab the patient as quickly as possible in the safest environment. The pool is a helpful medium to initiate therapy earlier in many cases and to speed the recovery process. Aquatic therapy also stimulates patient interest in swimming or water aerobics programs in the community so that the patient has a means of continuing a healthy habit for life. PTP
Carol Green, PT, COMT, Clinical Specialist II/Physical Therapist Level II, is a Certified Orthopedic Manual Therapist with OrthoCarolina Physical Therapy’s Eastover Office in Charlotte, NC. She has more than 29 years’ experience in physical therapy, including 27 years at OrthoCarolina. Green has served as the Chairperson of the Quality Assurance Committee for OrthoCarolina PT/OT and is an APTA Credentialed Clinical Instructor. For more information, contact [email protected].