Strengthening patients and practice through aquatic therapy

To help patients progress effectively and comfortably with an improved mental outlook—whether they are world-class athletes, postsurgical patients, or members of the senior population—get them in the pool.

At Drayer Physical Therapy Institute in Mechanicsburg, Pa, the ultimate goal is to help patients become independent members of the community, functioning in the activities they enjoy. The facility utilizes a warm water therapy pool and many additional tools within this aquatic environment to provide patients the treatment they need. Staff members strive to remove barriers between patients’ current conditions and the lives and activities they previously enjoyed. With the appropriate tools, aquatic therapy can offer a significant advantage to individuals who are unable to exercise on land because of postsurgical limitations, arthritis, sport-related injuries, spinal cord injuries, and many other challenges.

The following article explores the most significant reasons this facility utilizes the aquatic environment to treat its patients, along with a summary of specific tools Drayer incorporates within the water to make aquatic rehabilitation as effective as possible.

 Unloading the Joints 

Submersion in water provides a low-impact, low-weight-bearing exercise environment that minimizes the risk of injury or undue stress on the joints. A variety of manufacturers provide hydrotherapy pools to the physical therapy marketplace. These manufacturers include HydroWorx, headquartered in Middletown, Pa, which provides a range of hydrotherapy pools for patient rehabilitation designed by clinicians with versatility and space requirements in mind. Another company, SwimEx Inc, based in Fall River, Mass, markets a pool line that includes the Triton, featuring a 50-inch water depth and two benches for seated exercise, and other pools designed to provide therapy, rehabilitation, and conditioning. Aston, Pa-based Endless Pools is a firm that offers pools designed to be installed in existing rooms with multiple workout stations, dual-propulsion pools, as well as pools built to accommodate facilities that have limited space.

For Drayer’s aquatic needs, staff members and patients use the HydroWorx therapy pool, which comes standard with an underwater treadmill and resistance jets. With these tools, many treatment options become available, allowing nearly unlimited creativity to treat patients within the aquatic environment. HydroWorx combines the properties of water with recent technology to give patients an advanced rehab environment. While walking on an underwater treadmill, reduced body weight eases the pressure on joints so patients can move freely and still build strength. Resistance jets enable patients to improve balance while joints remain unloaded.

Therapists can achieve full weighting using an AquaJogger buoyancy belt, from AquaJogger, Springfield, Ore. This tool works to unload the joints. It suspends patients at shoulder level in deep water, allowing them to breathe normally and move freely while performing a wide variety of water exercises, while their joints are fully unloaded. For less physically able patients—such as those affected by a spinal cord injury or cerebral palsy—the Kiefer neoprene float swim collar, from the Zion, Ill-based company Kiefer, works well to keep the patient’s head above water.

 Research Study

In February 2010, The International Journal of Aquatic Research and Education published findings made by Dennis G. Dolny, PhD, and Eadric Bressel, PhD, from Utah State University. Dolny and Bressel’s study examined the levels of perceived pain and mobility in osteoarthritis (OA) patients after using underwater and land-based treadmills.

The results indicated that patients diagnosed with OA may walk on an underwater treadmill at a moderate intensity with less pain and equivalent energy expenditures, compared with walking on a land-based treadmill at a similar moderate intensity. Patients revealed that pain was 140% greater during land treadmill exercise sessions than during underwater treadmill exercise sessions. The researchers concluded that patients diagnosed with OA may receive the same aerobic conditioning with less joint pain and greater improvements in mobility by utilizing underwater treadmills in contrast to land treadmills.

 Water’s Natural Properties Benefit Patients

The water provides constant resistance and a soothing effect on patients or athletes of any age or ability. While patients move through the water, buoyancy significantly decreases the magnitude of the vertical ground reaction force. Adjusting water levels creates the ideal environment for patients to work through a program at various support levels, while maintaining proper walking mechanics and posture. Single-leg activities that would be impossible on land become possible in the water. The treadmill allows therapists to work patients forward, backward, and sideways—targeting certain muscles and working to improve important functions with less risk of falling or injury. Noodles and other common pool exercise accessories can assist in these activities.

Hydrostatic pressure enhances circulation and improves joint-position awareness. Patients actually have less swelling after a session in the water due to hydrostatic pressure. An older patient or someone recovering from surgery may feel unstable on land and at risk of falling. Yet in the water, assisted by buoyancy and hydrostatic pressure, patients can confidently practice many exercises that will lead to better outcomes. In warm water, patients experience muscle relaxation and vessel vasodilatation, resulting in an increase of blood flow to the injured areas and earlier healing. Postural corrections can be accomplished with less effort and discomfort.

The viscosity (drag) an aquatic environment provides is an excellent source of resistance for strengthening. Patients can improve mobility, strength, and function rapidly during the healing process.


Basic activities such as walking, cooking, and gardening—things individuals want to do without taking frequent breaks—become easier for patients as they build strength and stamina on the underwater treadmill.

Hand paddles, such as those made by Strokemakers, Scottsdale, Ariz, increase drag and exaggerate the patient’s movements to strengthen upper extremities and make it easier to find flawed patterns in movement. Kiefer ankle weights used within the aquatic environment add an extra component of resistance. As patients progress, resistance can be added via resistance jets or ankle weights to create a greater challenge for their session. They are available in weights varying from 1 to 5 pounds. Eventually, patients transition out of the water onto land, and the weights can serve as a helpful stepping stone.

An additional product that can be used to provide resistance exercises both in the water and in dry-land resistance exercise programs is the Pool Aqua Band from StretchCordz, a brand of NZ Manufacturing Inc, Tallmadge, Ohio. It is designed for applications that include aquatic therapy and rehabilitation, water aerobics and aquatic fitness programs, and dry-land resistance exercise programs.

To build upper body strength, the Kiefer silicone webbed swim gloves and foam water dumbbells are helpful. The dumbbells’ oversized design requires less hand constriction to grip and can be extremely useful for patients affected by arthritis. The Thera-Band FlexBar from Thera-Band/Performance Health, Akron, Ohio, can be an effective tool to improve grip strength and extremity stabilization by bending and twisting in the warmth of the pool. Hydro-Bells from Hydro-Tone Fitness Systems Inc, Orange, Calif, also target the upper body, providing smooth, stable resistance along any path of motion through the water.

Noodles, as well as belts, from manufacturers such as San Luis Obispo, Calif-headquartered Sprint Aquatics can be used to provide varying levels of resistance while assisting patients who may have a challenge remaining upright in the water. To enhance stability and support, the Theraquatics Water Running Belt from, Montgomery, Ala, can be used during water exercise, suspending the body in an upright position in the water at shoulder level.

For core strengthening, Kiefer glide kickboards offer steady grip while increasing resistance during standing, walking, or running.

Many of the pool accessories mentioned in this article may also be found through Advantage Medical, headquartered in Bolingbrook, Ill.

 Enhanced Mental Outlook

Many people report they simply feel good in the water. Drayer keeps its pool at
92 degrees, which works well for arthritis patients and athletes. Warm water and rigorous exercise work together to release endorphins, the hormones released within the brain and nervous system that reduce the perception of pain. Also, patients feel energized when they can move freely again in the water. This breeds confidence. Many arthritic patients have not attempted high-intensity training in years and feel an increased sense of accomplishment and confidence when they can again exert themselves at high levels. This leads to functional improvements and a greater sense of well-being.

As athletes see themselves walking and running again soon after ACL surgery, they begin to believe they will regain this ability on land. Accomplishing in the water what cannot yet be done on land provides assurance that full recovery is possible.

Standing Out in a Competitive Marketplace

When selecting a rehab facility, patients are looking for quality care and innovation. Technologically advanced treatment options such as the underwater treadmill and other state-of-the-art aquatic tools allow facility managers and owners to attract patients looking for additional treatment options. Offering warm water as the safe and low-pain method of rehab can create a niche as the “facility of choice” in a community.

Aquatic therapy—coupled with the correct tools and accessories—can help return patients to the activities they love; accomplishing this with less pain, and a more positive mental outlook while establishing a physical therapy facility as a unique, patient-oriented community asset. PTP

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Pool lifts for Access

Facilities vary regarding pool access—from stairs to ramps to mechical lifts—for all individuals. The addition of a pool lift ensures access for all levels of patients. There are many pool lifts on the market, including models that provide a stretcher, two-piece seat, or flip-up arms, such as those from Aquatic Access Inc, Louisville, Ky.

Among the company’s models for in-ground pools is the IGAT-180, certified to meet the 2010 Standards for Accessible Design and powered by water pressure. It is engineered to lift up to 400 pounds at 55 to 65 PSI open-flow water pressure. The lift also offers a custom heavy-duty modification to meet the needs of larger users. Aquatic Access above-ground lifts include the Pool Lift Model AG72 for walls 60 inches high, featuring assisted operation, a manual 360-degree seat turn, and the ability to lift up to 300 pounds at 55 to 65 PSI.

The Pine Island, NY-based SureHands Lift & Care Systems also offers a Wheelchair-to-Water Lift, built to take the patient directly from the wheelchair into the water. The mobile lift uses rechargeable batteries, is designed to easily engage and disengage from the floor socket, and features an
emergency stop button that halts all motion of the lifting arm. The SureHands Body Support and ceiling motor is also usable for hydrotherapy and targets a larger lifting range. It can be used for intensive use and
in pools where floor sockets cannot be installed.

ADA-compliant lifts can also be found
through Spectrum Aquatics, Missoula, Mont. Spectrum Aquatic offers electric-powered lifts that include the Freedom ADA-Compliant
Pool Lift, and Aspen ADA-Compliant Pool Lift, both of which offer a 350-pound lifting
capacity and 90 lifts per battery charge. The company’s water-powered lifts include the ADA/ABA-compliant Gallatin Water Power Assisted Access Lift for in-ground pools
and spas without customization, and the Glacier Pool Lift, a vertical lift platform designed to accommodate a wheelchair for individuals requiring stabilized support for entry into pools and/or spas.



Travis Baughman, DPT, Cert MDT, is the center manager for
Drayer Physical Therapy Institute in Mechanicsburg, Pa, one of more
than 100 facilities in 14 states. Drayer Physical Therapy Institute aims to provide an optimum level of patient care, and does not endorse any specific product or company. For more information, contact [email protected].