Aquatic Therapeutic Exercise

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Aquatic Therapeutic Exercise
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Benefits and Purpose of Aquatic Therex
Exercise sometimes possible sooner in water than
on dry land
Non weight bearing
Offers total exercise program cardiovascular
conditioning, flexibility, strength, muscular
endurance
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Specific Gravity
Also called relative density
Ratio of an objects weight to the weight of an
equal volume of water
Specific gravity of water 1
For human body, depends on lean and fat mass and
distribution of body fat
Average specific gravity for body 0.95-0.97
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Archimedes principle A body partially or fully
immersed in a fluid will experience an upward
thrust of that fluid that is equal to the weight
of the fluid the body displaces.
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Buoyancy
Archimedes principle
A body with a specific gravity of less than 1
will float because weight of water displaced is
less than weight of body
If body has specific gravity of 0.95, 95 of body
will be submerged and 5 will float
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Center of Buoyancy
The center of gravity of the displaced fluid and
the point at which the buoyant force acts on the
body
When in equilibrium, the center of buoyancy and
the center of gravity are in vertical alignment
with each other and the body is balanced
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Hydrodynamics
Viscosity
The resistance to movement within a fluid that is
caused by the friction of the fluids molecules
Influenced by cohesion, adhesion, surface tension
(continued)
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Hydrodynamics
Drag the waters resistance to a body that is
moving through it
Form drag
Wave drag
Frictional drag
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Hydrostatic Pressure
Pascals law Pressure from a fluid is exerted
equally on all surfaces of an immersed object at
any given depth
The more deeply the object is immersed, the
greater the pressure
For every foot of submersion, water pressure
increases by 0.43 psi
Positive impact on edema
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Pascals Law
Reprinted from Bates and Hanson 1996.
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Weight Bearing in Water
The more deeply the body is submerged, the less
weight is borne by the lower extremities.
Females center of gravity is lower than males
affects percentage of body weight borne at
different depths.
The faster a person walks in the water, the
higher the weight-bearing percentages.
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Weight Bearing in Water
Reprinted from Harrison, Hillman, and Bulstrode
1992.
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Aquatic Equipment
Safety equipment
Assistive devices help stabilize body, maintain
buoyancy, assist in motion
Resistive devices used to increase muscle
strength/endurance increase surface area,
require speed, add buoyancy or weight
Cardiovascular devices
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Indications for Aquatic Therex
Pain, edema, muscle spasm, loss of motion,
weakness, limited endurance
Restricted weight-bearing status
Maintaining cardiovascular conditioning or normal
status of uninvolved extremities
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Advantages
Can be performed even if weight bearing is
restricted
Warmth of water can relax muscles, relieve pain
Buoyancy reduces joint compressive forces
Reduces weight bearing while allowing muscles to
continue to function properly in the gait sequence
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Advantages
Can promote body awareness and balance
Can relieve or reduce pain due to immobilization
or edema
Can be used early in rehabilitation program,
helping to prevent deconditioning
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Precautions for Aquatic Therex
Fear of the water
Medications
Ear infections
Conditions such as diabetes, cardiovascular
disease, seizure disorders
Never allow patient in pool unattended
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Contraindications for Aquatic Therex
Contagious infection
Severe cold or flu
Urinary tract infection
Temperature of 100 F or more
Open wounds
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Application of Aquatic Principles
Hydrostatic pressure more advantageous to
exercise swollen extremity in deep water
Greater resistance achieved through
longer lever arm, straighter extremity
increased speed
moving object at surface of water or with
increased surface area
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Aquatic Exercise Progression
Early
Use buoyancy equipment for increased range of
motion.
Do gait training in deep water.
Use resistance exercises without equipment.
(continued)
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Aquatic Exercise Progression
Mid
Emphasize restoration of muscle strength and
endurance.
Use drag to increase resistance.
Add resistive equipment.
Increase reps and sets.
(continued)
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Aquatic Exercise Progression
Advanced
Focus on restoration of ABCs of proprioception
Gait training more intense and varied
Hopping, jumping, etc.
Eyes open, closed.
Increased intensity for strength
(continued)
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Aquatic Exercise Progression
End phase
Mimicking skills and demands of sport
Aggressive coordination, agility, speed activities
Plyometrics
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Benefits of Deep-Water Exercise
No weight bearing and no impact forces
Can help maintain cardiovascular fitness and
strength
Forces of gravity on a submersed body are minimal
Exercises essentially concentric
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Correct Vertical Alignment
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Correct Position for Deep-Water Running
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Refraction of Light
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Determining Depth of Water
Patients confidence in the water
Patients weight-bearing status
Goals of the exercise