Aquatic Physiotherapy: 4 Approaches for Novelty in Water

Aquatic Physiotherapy

What is Hydrotherapy?

Water based treatment
Used at its 3 states: solid ice, liquid water or steam gas
Goals: increase circulation and quality of blood flow


Some hydro baths are immersive where the body up to the shoulder is enveloped with water while others are shallow to target local regions of the body.

Hydro baths utilize different temperature settings for improvements in circulation of blood, and mechanical flow of water for general relaxation.

Physical Therapy often uses Aquatic Pools as a method of Hydrotherapy for Rehabilitation.

What are the fluid mechanical principles used in hydrotherapy?

❖ Buoyancy
❖ Hydrostatic pressure (increases as
water depth increases)
❖ Inertia
❖ Thermodynamics & Hydrodynamics
(fluctuations in temperature, fluidity of
motion and turbulence)
❖ Density & Viscosity

Water is 600-700 times denser than air, creating sustained resistance to motion
Turbulence from motion creates resistance at least 14 times that on land

What is the benefit of performing physiotherapy under water?

❖ Eases initiation and completion of range of motion movements
❖ Provision of support & safety as there is no fall risk
❖ Reduction of muscle tension and tone
❖ Promotion of axial neck and trunk control
❖ Appendicular limb strengthening activities
❖ Eases initiation of weight bearing activities (i.e. standing, walking)

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What are the physiological effects of aquatic physiotherapy?

❖ Increases work of breathing
❖ Increases blood volume pumped out of heart
❖ Improves venous return to reduce swelling
❖ Water flow induces relaxation and pain relief
❖ Stretches tightness

Water–based or Land-based physiotherapy? Which is better?

Literature compared conventional physiotherapy to aquatic pool based physiotherapy:

Aquatic pool based physiotherapy induced

  • Better functional reach 
  • Improved aerobic functional capacity & mobility as well as speed
  • Enhancement of balance, ambulation and limb coordination

when compared to land based conventional physiotherapy within the application of

5 sessions per wk for 40 – 45 mins per session for a duration of 4 weeks.

What are the common physiotherapy approaches for aquatic treatment?

WATSU (Water shiatsu),

a Japanese approach to controlling the body’s flow of energy. 

In this technique, the client is asked to completely relax and allow their body to be supported and moved along the flow of water and the pull and push forces by the therapist.

Watsu is administered by a specialized aquatic therapist with the aim of relaxation, reduction of pain and tension in the muscle.

Halliwick (Water Specific Therapy),

originally a technique designed to assist people with physical dependency achieve independence in underwater motion.

It’s main goal is to stimulate and challenge axial trunk control.

Nowadays it is often used by swimming coaches to instruct classes in a stage wise order:

  1. Mental adaptation
  2. Termination
  3. Vertical rotation
  4. Horizontal rotation
  5. Combined rotation
  6. Thrust
  7. Maintaining Balance
  8. Turbulence and sliding
  9. Basic Propulsions
  10. Simplified swimming

Aquatic physiotherapy utilizes some of these stages in the process of retraining postural head and trunk control and coordination.

Bad Ragaz Ring Method,

originally named after Bad Ragaz region in Switzerland known for its hot spring health and wellness resort, is an aquatic treatment that aims to increase strength and stability. 

Aquatic physiotherapists often combine the principles of BRRM with proprioceptive neuromuscular facilitation techniques to enhance the effect of treatment.

Approaches to this technique are usually combinations of active, where the client is asked to perform a specific motion, and passive, where the client allows the therapist to guide their motion for them.

Burdenko Technique,

often used on land as well as in water is a method of actively relearning the proper movement combinations through stages with a goal in each:

  1. Balance
  2. Coordination 
  3. Flexibility
  4. Endurance
  5. Speed
  6. Strength

This technique used in aquatic setting, utilizes the fluid mechanics offered by water to challenge the clients center of support and enhance the exercises done at each stage of rehabilitation.

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