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Aquatic therapy

Aquatic therapy refers to treatments and exercises performed in water for relaxation, fitness, physical rehabilitation, and other therapeutic benefit.

Aquatic therapy is physical therapy that takes place in a pool or other aquatic environment under the supervision of a trained healthcare professional. Aquatic therapy is also known as water therapy, aquatic rehabilitation, aqua therapy, pool therapy, therapeutic aquatic exercise or hydrotherapy.

Common goals of aqua therapy programs include:

aquatic therapy

Improving flexibility
Improving balance and coordination
Building muscle strength and endurance
Enhancing aerobic capacity
Assisting with gait and locomotion
Reducing stress and promoting relaxation
Aquatic therapy is different from aquatic exercise or aquatic fitness because it is a physical medicine and rehabilitation specialty that requires the involvement of a trained professional and is covered by many insurance providers due to the personalized nature of the treatment. Aquatic exercise does not need to be supervised by a trained professional. It is also not covered by insurance, and it often takes place in a group setting that includes multiple people with different levels of physical fitness.

Aquatic therapy should not be confused with adaptive aquatics, either. Adaptive aquatics is the process of teaching people with disabilities how to swim safely in the water. Aquatic therapy does not focus on teaching clients how to swim.

Water therapy services are generally offered in hospitals, sports medicine clinics and traditional outpatient rehabilitation centers. Senior living centers may also provide aquatic therapy services as a way to encourage their residents to maintain or improve fitness levels, balance and strength.


Aqua Therapy Benefits

These are some of the ways that water’s natural properties create an ideal therapeutic environment:

Warm water provides a relaxing and soothing environment for aching joints and muscles.
Water’s natural viscosity or resistance can be used for muscle strengthening and increasing rehabilitation progressions.
Buoyancy allows for flotation and reduces the effects of gravity on injured or aching joints and muscles.
Hydrostatic pressure supports and stabilizes the client, allowing people with balance deficits to perform exercises without a fear of falling, decreasing pain and improving cardiovascular return.
Turbulence and wave propagation let the therapist gently manipulate the client through the desired exercises.
The respiratory muscles are forced to work harder in the water, allowing for a natural strengthening that benefits the client long after the therapy session has ended.
Compared to other forms of physical therapy, aquatic therapy results in a higher client compliance rate and less pain throughout the recovery process. Opportunities to significantly minimize the pain a client experiences should be taken seriously because with less pain, a client can enjoy a higher quality of life.

Another important advantage of aquatic therapy is that it can often begin before land-based therapy. For athletes looking to get back into competition, or busy professionals who want to recover from surgery as quickly as possible, this makes a water-based program the natural choice.


Water therapy may be helpful for clients suffering from the following conditions:

Arthroscopic surgery recovery
Balance disorders
Aquatic Video LibraryBursitis
Cerebral palsy
Chronic pain
Idiopathic joint pain
Joint reconstruction surgery recovery
Joint replacement surgery recovery
Lower back pain
Orthopedic injuries
Parkinson’s disease
Multiple sclerosis
Rheumatoid arthritis
Spinal cord injury
Sprains and strains
Traumatic Brain Injury
People of all ages can enjoy water therapy benefits, including children with special needs and senior citizens. A trained therapist can create a session that takes into account any age-related physical limitations to promote a positive therapeutic experience.


Even though aqua therapy typically takes place in a fairly shallow pool, it is not risk free. To provide a safe environment for clients, aquatic therapy practitioners should be trained in first aid, CPR, oxygen administration, automated external defibrillation, blood-borne pathogens and risk awareness (check local codes for actual requirements).

The suitability for aquatic therapy for a client should be decided on a case-by-case basis. Here are some situations where aqua therapy may not be an appropriate course of treatment:

High fever
Open wounds (unless covered with bio-occlusive dressing)
Uncontrolled seizure disorders
COPD or other similar respiratory issues
Currently taking medication that could alter cognition
Client is currently pregnant and experiencing complications
Chlorine or bromine allergy
Serious fear of water
Clients with Hepatitis A


Pool Therapy Exercise StepsWhen aquatic therapy is intended to promote physical fitness, each session is broken into three parts:

Warm up: The client begins with low-resistance exercises designed to target the upper and lower extremities. This often includes stretches and extensions, followed by brief walking or jogging on an underwater treadmill.
Fitness and strength training: After the warm-up, the client will often perform cardiovascular activities such as running, sprint intervals or multi-planar activities. Strength activities, including plyometrics, can also be performed.
Core training: After fitness and strength training, the client does 20-30 minutes of squats, leg swings, arm swings, shoulder presses and other core-training exercises.
Cool down: Using a therapy pool with a massage hose attached to resistance jets provides a deep tissue massage experience that works muscles to prevent lactic acid buildup.



Water TreadmillRunning provides an excellent cardiovascular workout, but can lead to joint damage. However, with an underwater treadmill, it’s possible to enjoy all the benefits of running without the impact.

Underwater treadmills can be used to help athletes recover from injuries or to regain full-body motion after surgery. This is particularly useful if the athlete or patient is non or partial weight-bearing. High-end therapy pool models have resistance jets and adjustable speeds to allow for a gradual increase in workout intensity.

Benefits of using a treadmill as part of water therapy include:

Promotes early range of motion
Initiates gait training in a low-impact environment
Duplicates land-based movement biomechanics to improve client’s gait patterns more accurately than aqua jogging
Improves cardiovascular stamina
Impacts muscle strengthening
Increases ability to perform a wide range of plyometrics
Reduces blood pressure levels
Decreases joint stiffness
Offers the ability to perform exercises in multiple planes of motion
HydroWorx treadmills feature rubberized belts for extra traction and can be used with either bare feet or shoes. The treadmills accelerate from .1 mph to speeds of up to 10 mph, making them suitable for everything from walking and jogging to sprinting, side shuffling, backwards waking and carioca.

There are multiple types of aquatic therapy pools, ranging from small pools for single client use to large pools intended for group workouts. Therapists use cold-water plunge pools to speed muscle recovery in athletes and reduce joint inflammation. Hot-water plunge pools are used for relaxing muscles.

The newest models of therapy pools offer pinpoint temperature control and special massage hoses to target the specific muscles in need of treatment. A pool with underwater massage capabilities helps prevent lactic acid buildup, which reduces soreness and speeds recovery time. Massage can also provide an effective way to help people dealing with chronic pain.

Many therapy pools include stairs to promote safe accessibility for users with mobility issues. Therapists who frequently work with the elderly, small children or clients with serious injuries may utilize a pool with a moveable floor that makes it easier for clients to enter and exit the area. For example, the HydroWorx 2000 and 1200 Series pools feature a fully moveable floor that can be raised and lowered in less than 30 seconds to allow for a safe entry to the therapy session.

Adjustable water depth controls, whether standard or as an optional therapy pool feature, benefit therapists by allowing for easy adjustments to pool water levels. This allows for a therapist to determine what percentage of the client’s weight should be supported, creating a session that is tailored to the individual’s abilities.

Underwater cameras are key features in effective aqua therapy pools, as they allow for therapists to monitor the client’s form and progress from session to session or to make real-time adjustments. Clients can also use the cameras to provide an additional level of visual feedback as they work through a series of exercises.


In addition to a functional therapy pool, accessories are sometimes used to enhance a specific exercise. Accessories might include:

Stationary bicycles
Flotation rings or belts
Weight-adjustable barbells
Ankle weights
Short-tipped fins and flippers
Resistance bands and tubing
Resistance hand bells and paddles
The type of aqua therapy exercises a client needs will depend upon their required rehabilitation, physical limitations as well as the specific method of treatment. For example, the Bad Ragaz Ring Method relies on having the use of flotation rings around the client’s neck, arms, pelvis and legs. For aqua jogging, a flotation belt is used to ensure the client remains in an upright position with their head above water.

Aquatic therapy

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