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AQUATIC PHYSICAL THERAPY

The Therapeutic Effects of Water


Paula Godes, PT, DPT

Overview

History of Aquatic Exercise


What is Aquatic Physical Therapy?
Goals of Aquatic Physical Therapy
Who Participates
Hydrodynamics: Application of Newtons Laws

Law of Inertia
Law of Acceleration
Law of Action/Reaction
Waters Viscosity and Frontal Resistance
Center of Gravity
Center of Buoyancy
Hydrostatic Pressure
Surface Tension
Drag and Turbulence

What is Your Goal? - Return to Running


Our Program: Present and Future

History of Aquatic Exercise


Early writings in the Old Testament: Ascleius,

Greek God of Medicine


FDR: Therapeutic spa made by Native Americans
Early running rehab: track athletes 1970s
Research: 1990s and increasing
Boomers: Leading the way for alternative
exercises- over 10 million participated in aquatic
exercise (Aquatic Exercise Assoc., 2000)

What is Aquatic Physical Therapy?


Aquatic Physical Therapy is the evidence-based and skilled practice

of physical therapy in an aquatic environment by a physical


therapist or by a physical therapist assistant who is under the
direction and supervision of a physical therapist. Aquatic Physical
Therapy includes but is not limited to treatment, rehabilitation,
prevention, health, wellness and fitness of patient/client populations
in an aquatic environment with or without the use of assistive,
adaptive, orthotic, protective, or supportive devices and equipment.

The buoyancy, support, accommodating resistance and other

unique properties of the aquatic environment enhance interventions


for patients/clients across the age span with musculoskeletal,
neuromuscular, cardiovascular/pulmonary, and integumentary
diseases, disorders, or conditions.

What is the Difference?


Aquatic physical therapy requires the skilled service of
a PT and/or PTA which may include:

a) the clinical reasoning and decision making skills of a


PT/PTA;
b) the patient has impairments and/or disabilities which
can be minimized or eliminated with aquatic physical
therapy; and

c) the patient has potential for reaching new functional


goals/outcomes to improve quality of life and ease
burden of care.

Specialized Training
Is there a certification program for aquatic
physical therapy?

No; however, the APTA Aquatic Physical Therapy


Section is in the process of conducting a practice
analysis to see if there is a need for a certification
process.

What education requirements are needed to


specialize in Aquatic PT?

Water safety, risk management, and an


understanding of hydrodynamic principles and various
techniques.

Continuation Courses

Aquatic Therapy & Rehab Institute (ATRI):


certification and membership

Who Participates
The Elderly: those with painful, arthritic joints
Obese or sedentary individuals
Decreased function/weakness poor tolerance and

endurance for land exercises


Chronic illnesses/pain syndromes fibromyalgia, back pain
Those recovering from illness or surgery
Well-conditioned individuals or athletes: Advance training
using increased resistance of water/equipment

Goals of Aquatic Physical Therapy


Aquatic Physical Therapy interventions are

designed to improve or maintain:

function

aerobic capacity/endurance conditioning

balance, coordination and agility

body mechanics and postural stabilization

flexibility

gait and locomotion

muscle strength, power, and endurance

HYDRODYNAMICS:
Law of Inertia
An object will remain at rest or in motion

with constant velocity unless acted on by


a net external force
Total Body Inertia: requires more muscular
effort to start, stop or change movement.
Waters Inertia: increases resistance
Add travel through the water more effort

Law of
Acceleration
The reaction of a body as measured by its

acceleration is proportional to the force applied,


and inversely proportional to its mass.
In other words, if you use more muscular effort, you
accelerate (increase) the force.
Note: Going faster will increase intensity, but is
normally not recommended in a therapeutic
environment lose ROM- use force instead of speed
to increase intensity
The greater the body mass, the more force it takes to
move that mass

Law of
Action/Reaction
For every action, there is an
equal and opposite reaction

Viscosity of the water with arms and legs can


be used to assist or impede movement
Actions of the arms and legs working with each
other (assisting) or in opposition (impeding)
Example: jogging forward with front crawl arms
(assisting), less intense than jogging forward
pushing arms forward (impeding)

Waters Viscosity
Friction between molecules of

a liquid cause them to adhere to each


other (cohesion) or to a submerged body
(adhesion)
Resistance surrounds the body and affects
every movement in every direction
Larger surface area = MORE resistance
Smaller surface area = LESS resistance

Increasing
Intensity
Its NOT about speed!
Use inertia, acceleration, action/reaction, frontal

surface area, hand positions, levers, to increase


intensity much more effective
Use training techniques that maintain ROM
against the waters resistance
Most movements done in the water involve only
concentric muscular contractions - muscle
soreness is minimal

Center of Gravity
Center of a bodys mass
Position of body parts determine position
of center of gravity
Widen base of support stabilizes the
center of gravity
Men torso near the chest
Women torso nearer to pelvic girdle

Center of Buoyancy
Center of the volume of the

body displacing the water


Affects movement when submerged
Located in the chest area (lungs, air pockets)
Impacted by volume of air (inhaling or
exhaling), and by the density of the body
Muscle vs. fat Buoyant bodies have more fat

Buoyancy decreases effects of gravity-reduces


weight bearing/compression of joints

In water up to neck: 90% reduction


In water to waist: 50% reduction
Joint capsules OPEN when submerged greater
flexibility

Buoyancy
Force of buoyancy vertically

upward-movement toward the


surface of the pool - buoyancy assisted
Movement of a buoyant object toward the
pool bottom buoyancy resisted
Floating movement on the surface of the
water buoyancy supported
Biceps curls with foam dumbbells:
concentric triceps (buoyancy resisted)
eccentric triceps (buoyancy assisted)

Hydrostatic Pressure
Pressure increases with depth
Affects on body:
Increased blood flow from 1.8 to 4.1 mL/min/100g of
tissue = increased oxygen delivery and circulatory force
Improvement with dependent edema reduced swelling
Renal blood flow increased by 10% - increased urinary
output/waste excretion

Surface Tension
Force exerted between

the surface molecules of a liquid


Caution with arm patterns that move
above and below the waters surface
No snapping out of the water- especially
careful w/ buoyant equipment

Drag &
Turbulence
Drag is the force that you feel that

opposes your movements in the water


Drag affected by frontal surface area,
velocity and shape of object
Submerged movement resisted in all
planes of movement and in all directions
of movement by the waters viscosity and
drag properties

Why Deep Water Running?

The most biomechanically specific form of cross training for the runner

Alternative training during an injury excellent for stress fractures or


foot, ankle, or knee injuries for whom running on land is
contraindicated no impact

Provides a strengthening component land running doesnt

800 times denser than air and provides up to 12 times the resistance
Regular runners burn about eight calories a minute, aqua-runners burn
11.5 in the same time (with the same intensity)

Scientific evidence has demonstrated that deep water running results


in a sufficient training response in order to affect fitness improvement.
This has been further documented by studies that have shown
maintenance of exercise and performance in even competitive distance
runners while training strictly with deep water running for periods up
to six weeks long. (Dr. Robert Wilder, Director of Sports Rehab- UVA)

For Soldiers, a quicker return to running (TBD)

Aquatic Running Form


Running in deep water is performed with the body in a 5 degree

forward tilt. This bend should occur at the hips, nor from the spine.
The biomechanical movement patter of water running resembles that
used on land.

The head is held comfortably out of the water, facing forward; avoid
the forward head/shoulder posturing.

Maintain a neutral spine. Always use a buoyancy belt to maintain form.


The arm action is the same as for land running, with the primary

movement occurring at the shoulder and with the hands relaxed slight scapula depression and retraction

Hip flexion should reach approximately 60-80 degrees at the same


time the knees flex or extend.

Ankle movements should include both dorsi and plantar flexion.

Deep Water
Alignment Mistakes

Leaning forward
Snapping the knee when kicking
Exaggerated lumbar hyperextension
Cervical hyperextension (looking up)
Hyperextending elbows and knees
Movements without precision
Overflexing the knee joint
Neglecting hand positioning
Emphasize ADIM for pelvic alignment

Instruction Pearls
Find out who doesnt swim
Ensure proper amount of buoyant equipment is

used to suspend with head above water


Emphasize working at own pace use time, not
group counts
Check pain level before activity. Emphasize
aquatic therapy should not increase pain.
Stretching session afterwards great time to
increase ROM!

Our Program:
Goals and Future Direction
Our Capacity:

Tuesday/Thursday 0700-0800
10 scheduled slots + Acute walk-ins (10-12 avg.)
Must be evaluated by DeWitt Physical Therapist and
recommended for aquatic therapy: Max 8 sessions
MWR Benyaurd Indoor Pool
MWR lifeguards one therapist

Future: SPRING 2011?

Separate therapy pool: 1st floor


Daily therapy sessions: group and individual
Increased staff: 1-2 Therapists; 2-3 PTAs
Leader in Aquatic Research

AQUATIC ARMY STRONG

Who says its easy?

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