Kirsten Good at PhysioFunction looks at the positive impact of aquatic physiotherapy – often known as hydrotherapy – for people with neurological conditions
Many people enjoy the sensation and freedom they experience when immersed in water. From paddling in the sea to swimming, surfing, diving and socialising with family and friends, water as a medium has many benefits which can be dovetailed into the rehabilitation of multiple conditions and injuries.
Those with neurological conditions often experience many symptoms and changes both physically, physiologically and socially. Therefore, the use of water for aquatic physiotherapy, as a therapeutic medium, can dramatically enhance and compliment the rehabilitation programmes of these individuals.
Aquatic physiotherapy also known as hydrotherapy provides multiple benefits for rehabilitation in the therapeutic setting for musculoskeletal, orthopaedic and neurological conditions.
Aquatic physiotherapy is defined by the Aquatic Therapy Association of Chartered Physiotherapists (ATACP) as: “A physiotherapy programme utilising the properties of water, designed by a suitably qualified physiotherapist. The programme should be specific for an individual to maximise function which can be physical, physiological, or psychosocial. Treatments should be carried out by appropriately trained personnel, ideally in a purpose built, and suitably heated hydrotherapy pool’’. ATACP (2021)
When an individual is immersed in the water, there are multiple physiological effects of the pressure exerted by the water on the body.
The effect of the pressure exerted (known as ‘hydrostatic pressure’) on the body increases with water depth and is maximised with head out of water immersion. Therefore, if someone is immersed to waist height, the hydrostatic effects are significantly lower than if someone is immersed with their head out of the water.
The water also provides a buoyancy effect due to the upthrust of the water, and this explains the weight relief experienced as the depth of the water increases.
Therefore, the water pressure and buoyancy provide many therapeutic benefits of immersion before even participating in activity. Becker B (2009)
These include:
• Enhanced cardiovascular efficiency
• Reduction in blood pressure
• Reduced sympathetic autonomic activity
• Improved cerebral blood flow
• Potential to strengthen respiratory musculature
• Reduced systemic inflammatory activity
• Improved renal function
• Increased muscle perfusion
• Offloading joints, and increased circulation to joints
Bruce E. Becker, MD, MS
The aquatic environment has broad re
Many individuals also report an improved sense of well-being, reduction in pain and improved independence in activities they may struggle with on land.
Neurological conditions commonly present with one or more of the following symptoms: muscle weakness, sensory changes, spasticity, reduced muscle tone, joint instability, difficulty with balance, pain, impaired respiratory function, impaired function such as, walking, sitting balance and rolling.
In addition to the physiological effects of immersion, aquatic physiotherapy utilises the unique properties of water to:
- normalise muscle tone
- strengthen weak muscles
- improve posture and balance
- facilitate relaxation
- improve circulation
- provide pain relief
- develop joint stability and range of movement
- develop confidence
- improve cardiovascular fitness and endurance
- develop independence in functional tasks.
The aquatic physiotherapist may use buoyancy, turbulence and drag principles of the water with additional equipment to assist or resist limb and trunk movement, to mobilise joints and strengthen or stretch muscles. The physiotherapist will determine the best position for the patient to be in to achieve the desired therapeutic benefits and will be able to provide optimal handling and use of buoyancy aids to ensure maximum safety and support in the water.
Many neurological conditions or injuries have profound effects on a person’s ability to move with independence and regulate body temperature. The warmth of the water in a purpose-built hydrotherapy pool, allows them to achieve the benefits in comfort whether they are able to move independently or require therapeutic handling to move in the water. This often provides a huge sense of freedom, relaxation and enjoyment as part of the therapeutic programme.
There are a number of therapeutic techniques which may be used to work with the properties of the water, and these will differ depending on the needs of the patient. Some examples of techniques or treatment approaches that may be included are”
- Badragaz Ring Method – aquatic PNF
- Ai Chi- slow progressive postural control movements based on Watsu, Qi Qong and Tai Chi.
- Pei-Sing K et al (2020)
- Halliwick Concept- a disability swimming method following a 10-point teaching programme without the use of floats or goggles but working with the swimmers and helpers in the pool to engage in water activity and breath control.
- Aqua Stretch- a myofascial release technique in the water facilitated by the therapist.
- Watsu- a passive technique of aquatic bodywork for deep relaxation using stretching techniques and acupressure.
- Burdenko- A combination of water and land-based exercises following the idea of 6 essential qualities of human movement.
All the techniques utilise the unique properties of the water with therapeutic handling from a trained therapist. In some cases, group exercise can be thoroughly enjoyable, interactive and provide a progression from 1:1 therapy.
Many people enjoy the freedom of movement they get in the water and wish to return to swimming or being able to access a pool independently for leisure, holidays or group exercise.
Whether you can swim or not, the benefits of aquatic therapy for neurological conditions are numerous.
ATACP Guidance on Aquatic Physiotherapy 2021
https://www.aquastretchbykc.com/what-is-aquastretch
https://www.badragazringmethod.org/en/
Becker B (2009) Aquatic therapy: Scientific foundations and clinical rehabilitation applications
Pei-Hsin Ku, Szu-Fu Chen, Yea-ru Yang, Ta-Chang Lai, Ray-Yau Wang (2020) The effects of Ai Chi for balance in individuals with chronic stroke: a randomized controlled trial
