Physical therapists regularly look for opportunities to learn and try new things. Water allows them to have tremendous freedom to help patients explore movements and expand their abilities.

Physical therapists regularly look for opportunities to learn and try new things. Water allows them to have tremendous freedom to help patients explore movements and expand their abilities.

By Troy Moore, PT, DPT, CSCS

Hydrotherapy might occur in an aquatic environment, but don’t call it a watered-down experience. For patients recovering from trauma and surgeries, having the opportunity to rehabilitate in a pool modality can be a game-changer.

To be sure, all individuals in need of physical therapy have specific needs and physician recommendations, not to mention milestone expectations. Yet it’s tough to find any person in rehab who cannot benefit from at least spending part of the time in the water with a trained professional. Over and over, studies have shown how powerful a warm-water environment can be; it’s why our facility dove headfirst into hydrotherapy several years ago.

The Decision to Go Hydro

I’ve always been a proponent of rehabilitating patients in the water, but I originally had to take them to a nearby fitness center for their sessions. Instead of spending only 1 hour, it took 2 hours to complete four units of treatment. As if that wasn’t challenging enough, the fitness center started to go downhill; it was not well-kept the last time I brought a client there, and I vowed to never visit again.

My intentions toward having in-house hydrotherapy set me into motion, and I began exploring pools in earnest. Still, I knew it might be tough to incorporate a full-fledged therapy pool into our Midwestern United States facility. What I didn’t know is that there was a non-in-ground alternative to moving mountains—or at least construction equipment—giving facilities like ours the opportunity to offer hydrotherapy.

In 2015, I was introduced to the HydroWorx 300 system from HydroWorx, Middletown, Pa. This equipment held my interest, especially because it required less of a footprint than a traditional therapy pool. After conducting return-on-investment analysis, we decided that it was worth the investment. If we could get at least five patients in the water per day, we could profit. It was a doable goal, especially when considering the cost savings of no travel or downtime between land and water therapy sessions.

After many months of renovations, we were ready to unveil our updated hydrotherapy option.

What we discovered was that water works in more ways than we could have originally anticipated, especially when we had a modality readily available at our fingertips.

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

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

Aquatic Access Inc

Endless Pools

Hudson Aquatic Systems LLC


Nespa Tiled Spas

NZ Manufacturing

Sprint Aquatics

Sure Hands Lift and Care Systems

SPRI Products


Expected and Surprising Advantages of Hydrotherapy

As our team jumped into the deep end of aquatics, the following four significant benefits were discovered:

1) Hydrotherapy appeals to every population

The HydroWorx 300 allows us to control water depth, so it’s simple to put any patient—younger or older, shorter or taller—into our “pool.” Additionally, the seat allows patients with very limited mobility to feel confident and safe, especially those who have an underlying fear of water or cannot swim. While we anticipated this, we didn’t understand how far-reaching the advantages of consistent warm-water therapy could be.

What populations do we see most? Plenty of total hip and knee replacements, spine surgeries (water solves the problem of physical therapy without risk of compression), and adults with osteoarthritis and related conditions. They are in pain, many are overweight, and all feel incredible freedom in a buoyant, massaging environment.

Patients began to get healthier faster, not to mention without discomfort. Those who complained regularly during land physical therapy found the water to be a pain-free, exciting, and encouraging environment. Consequently, they began to achieve outcomes at a more rapid pace than if they had remained in just land-based physical therapy sessions.

2) Water creates its own buzz

We intended to market our hydrotherapy options to the public; after all, we invested a great deal of resources into making the dream come to fruition. It all began with Facebook ads and content before construction began; within a short time, we had more than 40,000 views. On top of that, we added a print advertisement in a local magazine.

Recently, we showcased an advertorial in a publication that focused on Robert, a Medicare patient who is in his 60s. He came to our facility with post-polio syndrome, a condition which left him in extreme pain. After rehabbing in the water, he’s making such gains that he drives to our facility—40 minutes each way—three times a week.

While all the marketing did wonders to get the public’s attention, word of mouth became just as important as advertising, video pieces, social media, and press releases.

People actually began stopping me—in Walmart, of all places—to say, “Hey! You’re the guys with that [hydrotherapy] machine!” This gave me an opening to explain how it worked and why we felt we were changing lives. And the video? I just pulled out my phone and showed it to them on the spot, much to their astonishment. Needless to say, the buzz helped keep the doors opening and building our clientele.

It’s worth point out that our competition, which does not have a hydrotherapy offering like ours, has come to play less of a role in our lives. We’re one of only two providers in our state to carry this brand of modality, and that translates to more referrals and interest. There are several manufacturers nationwide, however, that provide a range of hydrotherapy technologies appropriate for the physical therapy practice. Among them is Hudson Aquatic Systems LLC, Angola, Ind, which offers the AquaFit underwater treadmill system.

The AquaFit is designed as a private exercise chamber and includes an adjustable touch screen for easy control. Another source, SwimEx, headquartered in Fall River, Mass, offers a professional series of aquatic therapy pools that can be installed above or below ground, and include underwater monitoring systems and motorized treadmills as options.

3) Hydrotherapy reimbursements are profitable

From a purely financial standpoint, we were pleasantly surprised by how well insurance companies reimburse hydrotherapy. In our state, therapeutic activity in the water is several dollars higher per unit of reimbursement. Over time, the monies add up.

Another patient, a 25-year-old woman, fell from a deer stand. The fall resulted in complete paralysis of her left side. After aquatic treatments, she can walk again with only the assistance of a cane. In the water, she walks for an hour, and can handle intense treatment that would be impractical on land. As she’s improved, we’ve lowered the water in our HydroWorx 300 to build her endurance. Insurance pays for her visits, allowing her to make tremendous strides and helping us to recoup our costs.

Yes, we took a hit by investing upfront in the product. However, within 3 years, we will be generating so much income that it will keep paying for itself annually.

4) A pool modality makes physical therapists more creative

Physical therapy professionals regularly look for opportunities to learn and try new things. The pool allows them to have tremendous freedom to help patients explore movements and expand their abilities.

For instance, beyond the floats, kickboards, and other pool exercise tools, therapists can try other items, including balls and regular objects. The key is to get people motivated so they continue to come to sessions and remain compliant.

Another area that gives physical therapists opportunities for innovative communication and treatment is the way technology has been included in this modality. When Sara, who is 27, came to us after two ankle surgeries, she limped. Yet she didn’t realize she was limping; people around her had pointed it out.

Utilizing the underwater camera and real-time video monitoring capabilities of our pool equipment, we showed Sara what she was doing with her one foot and why it was causing stilted gait movement. It finally clicked with her, and she understood why she needed help. The camera, for her, was the best part of that initial session. Without it, she might never have experienced the “Aha!” moment she needed.

Hydrotherapy: An Option for Every Clinic

Once upon a time, clinics were relegated to only one type of hydrotherapy feature: a full-blown pool. Consequently, many opted out because of expense or concerns such as ADA-approved lift requirements and local, state and federal compliance considerations. Now, new modalities like the one at our physical therapy location have expanded the reach for even smaller facilities that want to compete and scale their patient bases.

Is hydrotherapy becoming a norm in the physical therapy industry? As patients and referrers become increasingly familiar with its benefits, there’s little doubt that it will continue to be in hot demand. It’s up to contemporary physical therapy providers to anticipate and fulfill current and projected requests proactively. PTP

Troy Moore, PT, DPT, CSCS, earned his bachelor’s degree from Emporia State University, his masters at Wichita State University, and his doctorate in 2009 from Regis University. He has been working in physical therapy since 2006 and now specializes in outpatient physical therapy, including chronic pain, sports injuries, postsurgical conditions, and spine-related conditions. In 2012, he founded Central Kansas Orthopedic Group Physical Therapy & Sports Medicine. Moore is a member of the APTA and the Kansas Physical Therapy Association. For more information, contact [email protected].