Aquatic Therapy for Improved Outcomes

Avoiding movement due to pain is incapacitating and can lead to long-term disability. Aquatic therapy is an effective treatment option that can not only help a patient physically, but psychologically as well (Koury). Problems including lower back pain, SIJ pain, hip pain, knee pain, and foot and ankle pain can all benefit from aquatic therapy.

There are two major benefits of aquatic therapy that can help patients.

One is the ability to increase range of motion without increasing joint stress. The buoyancy of water allows a decrease in body weight, leading to greater joint movements and a symmetrical gait pattern with less discomfort (McAvoy). A second benefit is the ability to safely provide resistance to movement for all three planes of motion in a controlled environment (Fappioano). Whether the patient has just undergone a surgical procedure, has an acute lower extremity injury, or has increased levels of arthritis, the properties of water can help. These properties are used to improve flexibility, strength, and endurance of the affected area, preparing for a safer transition to land-based exercise and overall function.

For the post-surgical patient, such as a patient with a total joint replacement, one can initiate aquatic therapy once the incision site has healed in order to work on weight-bearing activity. Usually, this type of patient benefits most from a combined aquatic- and land-based therapy approach. On land, one can work on non-weight-bearing activity initially. Over time, one can slowly decrease the amount of work done in the pool and increase the amount of work done on land for a graded return to functional activity.

For the patient who has an acute lower extremity injury, such as an athlete who just sprained their ankle or a runner who has Achilles tendonitis, some therapists like to initiate aquatic therapy to continue to reinforce proper movement patterns without stressing the affected structures. Furthermore, the hydrostatic property of water helps to drastically reduce edema of the affected area. Again, this type of patient will slowly return to land-based functional activity based on their symptoms.

For the patient who has increased levels of arthritis in the lower extremities or the back, aquatic therapy can help in several ways. The warm water and buoyancy help to soothe the patient, which makes them more likely to move through larger ranges of motion than they normally would on land. Over time, this movement should help to improve the lubrication of the affected joints, slowing the progression of arthritis and allowing the patient to improve their functional level with less pain. Depending on the severity of the arthritis, these patients can either progress to a land-based home exercise program or can find an appropriate, cost-effective way to continue their aquatic program at a local pool.

  1. Koury JM. Aquatic Therapy Programming: Guidelines for Orthopedic Rehabilitation. Champaign, IL: Human Kinetics; 1996.
  2. McAvoy R. Aquatic and Land Based Therapy vs. Land Therapy on the Outcome of Total Knee Arthroplasty: A Pilot Randomized Clinical Trail. The Journal of Aquatic Physical Therapy. 2009;17:8-15.
  3. Fappiano M, Gangaway J. Aquatic Physical Therapy Improves Joint Mobility, Strength, and Edema in Lower Extremity Orthopedic Injuries. The Journal of Aquatic Physical Therapy. 2008;16:10-15.