Physical therapy (PT) is a healthcare profession focused on restoring, maintaining, and maximizing a patient’s mobility, function, and overall well-being. PT employs various techniques, including therapeutic exercise, manual therapy, and patient education, to address impairments. Aquatic therapy, often called hydrotherapy or pool therapy, involves performing these interventions in a controlled water environment. This specialized approach leverages the unique physical properties of water to facilitate movements that might be painful or impossible on land.
The Professional Relationship Between Aquatic Therapy and Physical Therapy
Aquatic therapy is a specialized mode of delivery utilized within the overall practice of physical therapy. It is a setting and method employed by licensed professionals to achieve the goals set out in a patient’s plan of care. A physical therapist (PT) or physical therapist assistant (PTA) must design and supervise the water-based program for it to be classified as skilled, medically necessary aquatic therapy. The exercises are tailored to the patient’s condition, using the water’s properties to meet rehabilitation goals.
The distinction between medical treatment and general wellness is important. Simple “aquatic exercise” or “water aerobics” guided by a fitness instructor is focused on general health and is not physical therapy. True aquatic therapy involves a skilled assessment, a detailed plan of care, and continuous clinical decision-making by a licensed PT. This professional application ensures the water environment is used strategically to target specific functional deficits and promote recovery, making it a reimbursable healthcare service.
Therapeutic Properties of Water
The effectiveness of aquatic therapy stems directly from the unique physical principles of water, often referred to as hydrodynamics. Buoyancy is the upward force exerted by a fluid that opposes the weight of an immersed object. This upward force reduces the gravitational load and weight-bearing strain on joints, allowing movement with less pain and stress. For example, a person standing in neck-deep water bears only about 10% of their body weight, enabling early mobilization after injury or surgery.
The viscosity of water provides a natural, adjustable form of resistance. This internal friction creates a drag force that opposes movement. Moving a limb slowly provides gentle resistance, while increasing speed or using paddles increases the workload. This allows for progressive muscle strengthening without traditional weights and improves motor control by slowing movement.
Hydrostatic pressure, the pressure exerted by the fluid, acts uniformly on all immersed surfaces. This constant pressure helps manage peripheral edema, or swelling, by assisting venous return and encouraging fluid displacement. The pressure also provides deep proprioceptive input, enhancing body awareness and stability, which benefits balance training. Furthermore, the warmth of the therapy pool, typically maintained above 90 degrees Fahrenheit, aids in muscle relaxation, reduces pain, and increases circulation.
Conditions That Benefit Most From Aquatic Therapy
Aquatic therapy is often the preferred initial intervention when land-based exercise is too painful or risky.
Musculoskeletal and Post-Surgical Recovery
Patients with severe musculoskeletal conditions benefit, as the water’s buoyancy provides a pain-sparing environment. This allows individuals with painful joints to perform range of motion and strengthening exercises that would be intolerable on land. Post-surgical patients, particularly those recovering from joint replacements or orthopedic trauma, benefit from the reduced weight-bearing environment. Immersion up to the chest can reduce the load on the lower extremities by 70% to 80%, allowing for earlier initiation of gait training and therapeutic exercise without compromising surgical precautions.
Neurological Conditions
Neurological conditions also respond well to water-based interventions. The supportive nature of the water minimizes the fear of falling, which hinders balance and gait training. The viscosity and hydrostatic pressure provide sensory feedback and a controlled environment for improving coordination and stability, allowing patients to practice complex movements with reduced risk.
Conditions that benefit include:
- Osteoarthritis
- Rheumatoid arthritis
- Fibromyalgia
- Stroke
- Multiple sclerosis
- Parkinson’s disease
Provider Credentials and Treatment Settings
Aquatic therapy must be provided by a licensed Physical Therapist (PT) or a Physical Therapist Assistant (PTA) under PT supervision. These professionals possess the necessary education and licensure to evaluate a patient’s condition, formulate a treatment plan, and utilize water’s unique properties for medical rehabilitation. Although no law mandates specific aquatic certification, many therapists seek advanced training through organizations like the Aquatic Therapy and Rehab Institute (ATRI) to demonstrate competency.
Aquatic therapy is primarily conducted in specialized rehabilitation pools, distinct from typical recreational pools. These pools are usually heated to 90 to 94 degrees Fahrenheit to facilitate muscle relaxation and pain reduction. The facility must also be equipped with accessibility features, such as ramps or specialized lifts, to ensure safe entry and exit for patients with severe mobility impairments. This specialized setting and qualified personnel differentiate medically necessary aquatic therapy from general pool fitness classes.