Chapter 17
Aquatic Physical Therapy
Copyright 2005 Lippincott Williams & Wilkins
Physical Properties of Water –
Buoyancy
Main Controlling Variables:
1. Position or direction of movement in
water
2. Water depth
3. Lever arm length
4. Flotation or weighted equipment use
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Position and Direction of Movement
Movements toward the surface –
Buoyancy assisted.
Movements parallel to the bottom of
the pool – Buoyancy supported
(gravity minimized).
Movements toward the bottom of
pool – Buoyancy resisted.
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Depth, Lever Arm Length, or Buoyant
Equipment Can Alter Resistance
or Assistance
Shallower water – Less support.
Deeper water – More support, but increased
frontal resistance.
Modifications can be made through use of
buoyant equipment.
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Buoyancy and Lever Arm
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Buoyancy and Flotation
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Resistance Is Influenced By:
1. Velocity of movement (mean muscle
activity alters when velocity reaches
a threshold (See Table 17-1)
2. Surface area
3. Water depth
4. Direction of movement
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Physiologic Changes with Immersion
(Changes vary with immersion depth)
1. Decreased peripheral blood flow, vital
capacity.
2. Increased heart volume, intrapulmonary
blood volume, right atrial pressure, left
ventricular end-diastolic volume, stroke
volume, cardiac output.
3. Decreased or unchanged heart rate.
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Physiologic Response to Exercise
and Immersion
Physiologic adaptations are
similar to land training.
Increased cardiac loading due to
hydrostatic pressure.
Depth of immersion affects
degree of cardiac changes.
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Examination and Evaluation for Aquatic
Rehabilitation
Full land-based examination must be performed.
Also consider:



Basic safety (ability to enter water, comfort, etc.)
Precautions (cardiac history, etc.)
Contraindications to aquatic environment (fever,
infections, rashes, etc.)
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Therapeutic Exercise Intervention
Mobility Impairment
Progress simple ROM exercises toward
functional limitations.
Use lever arm length and buoyant equipment to
alter resistance.
Observe land mechanics before pool exercise to
ensure proper technique.
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ROM
(Hamstrings and Shoulder Extensors)
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Muscle Strength/Power/
Endurance Impairment
Principles and progressions are the same as on
land.
Resistance is influenced by surface area (SA)
and direction. Consider gloves, etc. to increase
SA.
Be aware of groups providing stability.
Leg and trunk stabilizers are necessary to
counter many upper extremity movements.
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Balance Impairment
Ideal environment for balance training.
Variety of activities can be performed.
Loss of balance is slowed dramatically.
Allows for increased reaction time.
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Aquatic Therapy to Improve Balance
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Aquatic Rehab to Treat Functional
Limitations
As patient improves, modify activities to
address functional limitations.
E.g., decrease level of water as sitting
activities improve.
As normal mechanics improve, decrease
water levels to replicate land-based
environments.
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Land-Based Functional Activities in
Water
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Contraindications/Precautions
Individuals with
excessive fear
Open wounds
Rashes
Active infections
Incontinence
Tracheostomy
CV changes
Diuresis
Overexercise
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Summary
 Pool provides a unique environment for
rehabilitation.
 The properties aquatic therapy provides
can be used in many ways to achieve
therapeutic goals.
 Physiologic responses, temperature, and
hydrostatic pressure must be considered for
safety.
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Summary (cont.)
 Aquatic therapy can accommodate activities and
progress from early-functional stages.
 Balance is challenged with most movements
and stabilizing muscles must be considered.
 Pool program should include a land-based
program for a well-balanced transition to the
land environment.
Copyright 2005 Lippincott Williams & Wilkins