CLARION — Dating back to the time of the ancient Greeks and Romans, water therapy has been used as means of treating those who are sick, injured or experiencing debilitating conditions. Aquatic physical therapy continues that tradition, gaining traction as a complement or alternative to traditional land-based therapeutic services for those with musculoskeletal, neuromuscular, cardiovascular and pulmonary disorders or conditions.
With the 40 x 80 foot pool at the Clarion YMCA at its disposal, Clarion Rehab Services (CRS) began offering aquatic-based therapy in April. Justin Radaker, a physical therapist who directs CRS’s aquatic therapy program, is quick to extoll the virtues of providing treatment in the YMCA’s pool.
“It’s just physical therapy, but we put you in the pool for your exercise. It’s really good for people that want to take weight off their joints for back pain, hip pain, knee pain, ankle pain. After a surgery where you have trouble walking, we put you in the pool and the water supports you so that you don’t have as much force on the joints and it helps a little with balance,” Radaker said.
“I think people are able to tolerate a lot more (exercises) because they don’t have as much pain. If someone’s coming with knee pain and we make them do exercises on equipment or with weights, it just makes it worse. Being in there (the pool), they don’t have as much pain and they can do more exercise.”
The benefits of aquatic physical therapy stem in large part from the clinician making use of water’s properties, especially buoyancy, hydrostatic pressure and resistance/viscosity to assist the patient in performing a prescribed program.
Water’s buoyancy reduces the effects of gravity on the body and has been found to decrease weight bearing load, stress and compression of joints, fear of falling and blood pooling. Hydrostatic pressure, the force exerted on an immersed body by fluid, can positively affect an individual’s cardiovascular, renal, respiratory and nervous systems. Because of water’s viscosity, consistent amounts of resistance are provided throughout a movement so that all muscles are worked equally. Such resistance can increase muscle strength and tone, facilitate muscle balance, decrease swelling and improve cardiac and pulmonary output.
CRS owner and president Seth Babington, also a physical therapist, considers water another tool among the many that clinicians are trained to work with as part of their education. “That’s covered as part of our extensive training (which lasts from six to eight years). The exercise prescription, how we manage patients and treat them, that’s all covered. The pool is just a different modality, just a different form,” Babington noted.
When in the pool, therapists can make use of a variety of devices to help patients reach their rehabilitation or habilitation goals. Those accessories, which might be used to enhance exercise, include floating rings or belts, weight-adjustable barbells, ankle weights, short-tipped fins and flippers, resistance bands and tubing, kickboards and pool noodles.
Said Babington, “We use a lot of tools. We have a resistance jet which is cemented into the foundation of the pool. We have all kinds of really cool equipment to either help with balance, aid in the ability to perform exercises, or give resistance.”
Sometimes the first step in the therapeutic process is overcoming a patient’s hesitancy about or even fear of getting into the water. “They (patients) will say ‘Oh, I don’t swim’ or ‘I’m afraid of water.’,” Radaker said. “I have vests I can throw on their chest; I have floating dumbbells; I have an aquatic walker that holds and supports you. So I’ll start off with that stuff. Try to do some stuff to get them a little bit more comfortable.
“It’s only three-and-a-half to five feet deep. Once they start to realize that ‘if I fall over, I can stand back up’ it’s really not as bad.”
Aquatic physical therapy has been proven effective for individuals across the lifespan, though patients must, at a minimum, be continent of both bowel and bladder. “We can see anyone, from probably 2 or 3 (years old) to 100,” Babington said.
“Right now I mostly deal with middle-aged to older individuals. I’ve had as young as 11 or 12. We’d have to be a little creative if it was a toddler,”Radaker said.
Perhaps one of the biggest misconceptions many observers have about physical therapy in the pool is that it is a general class or program for everyone, such as cardio aquatics or a form of swimming lessons. “It’s not a class. This is physical therapy. I do an evaluation. I can do everything else that you would do in a land-based clinic, it’s just your program and exercises are performed in a pool,” Radker said.
Added Babington, “You need a referral from your physician for physical therapy. We then decide if they (the patient) can benefit from therapy in the pool and/or on land. But typically we require a physician’s referral. So people need to talk with their doctor and get a prescription.”