Physical therapist safely lowers a patient into the pool on an Aquatic Access chair.

Physical therapist safely lowers a patient into the pool on an Aquatic Access chair.

By Daniel Seidler, PT

Since civilization’s earliest history, people have discovered that exercising in water promotes healing and health. By the turn of the 20th century, Americans began utilizing water’s restorative properties to help children with disabilities. In 1910, the Spaulding School for Crippled Children in Chicago utilized wooden water tanks for paralyzed patients to exercise in.

Today, aquatic therapy has become a “norm” in high-tech training and rehab centers around the world. Its presence is now commonplace in organizations that include the Andrews Institute in Gulf Breeze, Fla; the elite running group known as The Oregon Project; as well as many of the top professional and collegiate football, basketball, soccer, baseball, hockey, and rugby teams around the world. This same modality is available to virtually any physical therapy practice.

Why Install a Pool?

At WSPT, we have found aquatic therapy to be one of the best modalities we can offer, not only for patient satisfaction and improved outcomes, but also as an additional revenue stream for our practice. Aquatic therapy helps our facility stand out as the “facility of choice” in the area. We have become known as the place with the warm water therapy pool—the only one in our metro area in private practice. This demonstrates to the community our interest in patient health and satisfaction, while also attracting the attention of local surgeons.

Benefits for Patients

Our practice uses the pool for a wide range of our patient populations, depending upon need. Individuals with chronic pain, weight-bearing issues, obesity, muscle soreness, and balance issues can especially benefit from the water. Hydrostatic pressure promotes healing and strengthening of injured tissue by reducing joint stiffness, decreasing swelling, and lowering blood pressure levels, thus increasing positive patient outcomes.


Before investing in a pool, several considerations must be addressed:

Staff training and needs

A properly trained staff helps ensure a successful aquatic program. When staff members can explain to patients the merits of buoyancy, resistance, hydrostatic pressure, and what they can expect to gain through the use of a pool, the probability of compliance and successful outcomes increases.

I always tell therapists with minimal aquatic experience to try doing some of the same exercises in the water as they usually do on land and see what happens. Chances are, their patients will tolerate the activity longer, experience less pain, and increase range of motion while in the water.


Pools must be maintained on a daily, weekly, and monthly schedule. This is vital. In our practice, we have 10 or more people in our 2,500-gallon pool each day. Therefore, caring for the pool is essential and requires a well-thought-out plan.

Regarding repairs, we decided the best route for our practice would be a service contract. Service reps come out twice a year and fix any potential problems. When situations arise, they are quick to respond.

“Partner” Relationship

I wanted to work with a manufacturer who felt more like a partner than a vendor. When we purchased the pool, we were building out a new facility and required a company that I felt would advocate for us and was also willing to act as a consultant to provide the best product for our needs.


As a practice, we did not want to invest in a product that would need to be replaced in a few years or require heavy maintenance. I needed something that fit my space, would hold up under heavy usage, and not nickel-and-dime me in maintenance. I went with a firm that had a solid service record with direct service personnel and a great reputation.

Return on Investment

Most pool manufacturers should help potential buyers with a return on investment (ROI) model, including construction costs, facility modifications, capital expenses, and revenue stream possibilities from wellness programs, increased census, or an increased referral base. But in the end, when a practice offers a pool and makes the right people aware of its availability, these individuals will seek out this type of treatment. The pool will then become a large part of the practice.

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

The following companies also offer products for aquatic therapy:

Advantage Medical

Aquatic Access Inc


Aquatic Therapy & Rehab
Institute Inc

Danmar Products

Endless Pools

Hydro-Tone Fitness Systems Inc


NESPA Tiled Spas

NZ Manufacturing Inc/

Performance Health/Thera-Band

Spectrum Aquatics

SPRI Products

Sprint Aquatics

SureHands Lift & Care Systems



Additional Equipment for Use in the Pool

Various forms of equipment can be used as adjuncts to support the aquatic environment, making it less static and more progressive. These include underwater treadmills, resistance or massage jets, and various weights and floatation devices.


After looking at many makes, models, and manufacturers of therapy pools, we went with a HydroWorx 500 Series pool from Middletown, Pa-based HydroWorx, which comes standard with a built-in underwater treadmill and resistance therapy jet technology. Many of our patients cannot walk without the use of the water, and on the treadmill they can utilize correct gait patterns while gradually becoming accustomed to bearing weight. Also, many athletes with injuries use the pool and treadmill to continue cardio workouts while they are non-weight-bearing, incorporating lateral movement and backward running. Additional treadmill and pool options can also be found through manufacturers that include SwimEx, Fall River, Mass, and Endless Pools, based in Aston, Pa.

Therapy Jets

Directional jet systems are essential for rehabilitation, resistance exercise, competitive sports training, swimming in place, deep tissue massages, and stripping lactic acid from tired muscles. The jets are also excellent for core strengthening and balance

Physical therapist instructs a patient on an aquatic treadmill, one of the many forms of equipment that can help support the aquatic environment.

Physical therapist instructs a patient on an aquatic treadmill, one of the many forms of equipment that can help support the aquatic environment.

Upper- and Lower-Body Strengthening

HydroBells, available through Hydro-Tone Fitness Systems Inc, headquartered in Orange, Calif, are great for core stability and strengthening in the water. The high-impact plastic provides an ideal arm, chest, and upper-body workout. As a patient progresses, adding resistance from the therapy jets with HydroBell exercises allows the clinician to increase the intensity of the exercise without increasing risk of injury. Hand bouys, available through companies that include SPRI Products Inc, Libertyville, Ill, can also be used for upper-body conditioning in the water.


We use noodles manufactured by Sprint Aquatics, San Luis Obispo, Calif, for patients who need floatation and resistance. Several exercises are beneficial with the noodle, including a one-leg balance, where a patient stands on one leg while raising the other knee to hip level, with the noodle forming a “u” under the raised foot. Noodles can also be found through a variety of companies, including Montgomery, Ala-based, as well as AquaJogger, Springfield, Ore, which markets the Sqoodle water exercise noodle.


For fibromyalgia patients in severe pain, we sometimes outfit patients with Speedo vests and a couple of noodles under their legs, allowing them to relax and float in the warm water. Additional resources for vests include HYDRO-FIT, Eugene, Ore. After sitting in a chair most of the day, this strategy offers great relief and helps them look forward to—rather than dreading—their therapy sessions.


We use the ADA-compliant Model IGAT-180-AD hydraulic lift by Aquatic Access, Louisville, Ky. This was installed into the deck in our facility. It is low maintenance, easy to use, and reliable. With a hydraulic lift, there are no lithium ion batteries to charge or replace, nor are electronic repairs required. Our lift chair has a 250-pound weight limit. For some of our patients, a lift is an absolute necessity. Spectrum Aquatics in Missoula, Mont, also markets a range of ADA-compliant lifts that are water-powered and battery-powered. SureHands Lift & Care Systems, Pine Island, NY, also offers lifts for safe patient handling around pools and spas.

Additional Programs

When aquatic therapy becomes part of the practice, special programs can then be offered, such as wellness programs with private pay for pool time, youth swimming classes, group classes, and more. We have tried a few programs throughout the years with varying degrees of success.

With the help of a therapist who also happened to be a swim instructor, we initiated a “Learn to Swim” class for local 5- and 6-year-olds. The warm water and personalized instruction were attractive to the swimmers and their parents, and this program served as a nice outreach to our community. It brought in people who, without the program, had no reason to enter our building. Yet, because of the program, they were introduced to our location, our attention to quality care, and dedication to the community.

Integrating a pool into your facility helps your practice stand out in the marketplace and shows the community at large your attention to patient satisfaction and improved outcomes.

As you become known as the “facility of choice,” new patient populations will seek out your practice and this new modality. Working together with a manufacturer as “partners,” you will determine the best pool and accompanying products for your individual market and practice. PTP

Daniel Seidler, PT, is the owner of WSPT, with three locations in the Bronx and Westchester, NY. WSPT provides highly advanced physical therapy, aquatic therapy, and wellness services to patients. Seidler does not endorse any specific product or company. He specializes in orthopedic and aquatic physical therapy. Seidler also contributed to Wilk and Joyner’s “The Use of Aquatics in Orthopedic and Sports Medicine Rehabilitation and Physical Therapy” with a chapter on the treatment of chronic pain and fibromyalgia. For more information, contact [email protected].