Musculoskeletal problems can vary from simple muscle strain to status post spinal fusion or joint replacement surgery. Patients who have muscle injury (strain, sprain, or mild tear) usually experience difficulties with functional activities. If the injury is in the lower extremity, then it affects the patient while walking, going up and down stairs, or sitting. If the injury is in the upper extremity, then it affects the patient while reaching, pushing, or lifting. If the problem lies within the joint, such as what is associated with arthritis, stiff joints, or the postsurgical period, the patient usually presents with problems while loading that joint during standing, walking, or doing similar activities.
Where weight-bearing can be an issue in the rehabilitation process, outpatient clinics may find that aquatic therapy can be beneficial in helping the therapist to better rehabilitate the patient in a non-traditional way. Aquatic therapy can not only provide a way to help unload the joint, but the warm water used in therapeutic pools aids circulation and therefore helps with muscle recovery.
Pressure, Temperature, Resistance
Aquatic therapy was integrated to expand the patient-treatment options available at Southfield, Mich-based OMPT Specialists. The services at this practice combine a treadmill within a private therapeutic pool that can decrease joint stress for clients who may be recovering from surgery, have pain in the lower extremities, or may be affected by back pain, arthritis pain, gait disturbances, and other painful conditions.
The aquatic environment in general helps to provide hydrostatic hypotension while standing and also helps to reduce dependent edema. To provide the foundation for its aquatic therapy services, OMPT Specialists has installed an AquaFit from Hudson Aquatic Systems LLC, Angola, Ind. The viscosity of the water in the AquaFit provides resistance to the user’s movement, and the jets in the water provide excellent controlled resistance to the patient during gait training.
Another beneficial aspect of water-based therapy that is useful to the therapists at this practice is the ability to apply the turbulence generated by the AquaFit to assist in improving passive, active, or assisted range of motion. The unit is also sometimes used with postsurgical rotator cuff repair to hasten the healing process during the first two phases of recovery. Likewise, the jet stream will add resistance to bilateral shoulder adduction or abduction if this is what the therapist needs to train.
Pools, spas, and accessories for water-based rehabilitation are available from these manufacturers:
Aquatic Access Inc
Hudson Aquatic Systems LLC
Nespa Tiled Spas
Sure Hands Lift and Care Systems
Finding the Right Fit for Aquatic Therapy
OMPT Specialists is a well-established outpatient physical therapy practice with seven locations in southeast Michigan, all of which are focused on delivering one-on-one care and evidence-based practice with an emphasis on musculoskeletal diagnosis. The purchasing process for the aquatic therapy infrastructure the practice wanted to install involved considerable research that included a thorough evaluation of the various water-based therapy technologies on the market. After an active search period for aquatic therapy equipment that would best suit the needs of all of OMPT Specialists’ clinics, the discovery process led the purchasing team to the AquaFit, which is an underwater treadmill unit.
The purchasing team concluded that this device best provided the features and functions that meshed with the practice’s needs. Among the factors that influenced the decision was what the purchasing team felt to be a reasonable price, ease of installation, ability to move the device if a clinic should need to relocate, and a functional treadmill. The fact that the unit takes one patient at a time also positively influenced the purchase decision. Additional factors include its adjustable water height, seat for the patient to use in the water, jets for resistance, and a transparent tank for the therapist to see patients for proper feedback with gait training. Another important quality is that the unit is easy for the staff to clean and maintain. Quite simply, it met the practice’s needs.
As awareness grows about the clinical applications of aquatic therapy—and potential revenue streams it can help attract—an increasing number of water-based technologies have entered the physical therapy space. While the AquaFit underwater treadmill system with its private exercise chamber was the right choice for OMPT Specialists’ needs, other practices expanding into aquatic therapy will find plentiful options including products that do not require special construction or buildouts. One such example is the HydroWorx 300 family of self-contained underwater treadmill devices from Middletown, Pa-headquartered HydroWorx, designed for installation that requires no additional construction. These units have sufficient space for a single user or a user and a therapist, and have a multi-directional therapy jet. The 300 series also has an adjustable water level and is controlled by a touchscreen panel that can be positioned for use inside or outside the unit.
Larger Sizes for Multiple Users
In cases where space and construction are not an issue, larger pools built for above-ground or below-ground use are also available that offer specialized functions that are useful to the PT clinic. SwimEx, headquartered in Fall River, Mass, offers the 500 T Series Hydrotherapy Pool in several configurations. 500 T Series pools have an adjustable floor, two multipurpose water depths, and eight colored performance zones. A 50-degree angled running pad allows users to run against a current in a limited weight-bearing environment and a water current that has 99 water speeds. Hudson Aquatic Systems also offers commercial therapy and performance AquaPools in a variety of sizes and equipped with options such as spa jets and resistant swim currents. The company’s in-ground pools reach a maximum size of 40 feet by 40 feet, a maximum water depth of 71 inches, and can be equipped with options such as underwater treadmills, therapy jets, resistance jets, swim current, exercise rails, and a therapy bench. The AquaPool line is available in custom sizes and depths, and designed so that the entire pool will fit though a 36-inch door.
HydroWorx also provides larger-size pools, including the company’s 2000 Series variable-depth hydrotherapy pools, which have vertically moving floors and an underwater treadmill that measures 8 feet by 12 feet. These pools are built to be accessible and accommodate up to four people during therapeutic activities and have underwater video monitoring capability. Another manufacturer of larger pools is Endless Pools, Aston, Pa, which offers a commercial series that features a variable-speed swim current and hydraulically powered underwater treadmills. Pools in this series are available with custom sizing and choice of depths, with a dual-propulsion model that allows multiple patients and two swimmers to use independently controlled swim currents.
Different Use for Aquatic Therapy
OMPT Specialists uses the AquaFit to address a variety of diagnoses and rehab goals, including unloading the joint with standing and/or walking. The device provides an excellent environment for that purpose, and the therapists can use the treadmill at a very low speed or increase to a higher tempo, if needed. It is also used for patients who are affected by muscle injuries such as those in the quadriceps or hamstring, as well as calf strains or sprains. The warm water helps to improve the circulation and, thus, promotes recovery.
The AquaFit also allows patients to enter or exit without the need for steps, ramps, or a lift, and is useful for postoperative care when the patient cannot tolerate a land exercise program. Some examples of postoperative situations for which this aquatic device is useful are hip or knee replacement, ACL repair, S/P meniscus repair surgery, Achilles tendinitis, S/P Achilles rupture repair, spinal laminectomy, spinal fusion, and upper extremity S/P surgery such as shoulder S/P labrum repair or S/P rotator cuff repair surgery.
Accessories such as weights designed especially for the aquatic setting can add resistance if desired, and increase the creativity with which therapists are able to design therapeutic activities. Taken together with the beneficial properties of water itself—buoyancy, viscosity, resistance, and temperature—aquatic therapy provides an effective tool for treating the physical therapy patient. From a clinical perspective it enables some patients to perform movement and repetition that would not otherwise be possible on land. From a business perspective, aquatic therapy can provide a good financial return on investment for any outpatient therapy clinic that is looking to increase its revenue. PTP
Michael Fahmy, PT, has more than 25 years of experience working in orthopedic outpatient clinics. He is the founder and owner of OMPT Specialists Inc and owner of Athletic Republic – Shelby (Sports performance training facility) in Michigan. For more information, contact PTPEditor@medqor.com.