Dr. Fahmy Imam Fahmy MD
Professor of rheumatology and rehabilitation Azhar University
A quatic therapy is the 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 or hydrotherapy. Current rehabilitation professionals generally define hydrotherapy as a pool therapy program specifically designed for an individual in an attempt to improve neuromuscular and skeletal function. The use of hydrotherapy as rehabilitation tool was first described by Hippocrates (450 - 375 BC) and is now commonly employed by physiotherapists and occupational therapists. The use of water for restorative purposes has grown in popularity and has gained increased use in facilitating therapeutic exercise(1). The unique physical properties of the aquatic environment provide clinicians with treatment options that may otherwise be difficult or impossible to implement on land.(2)
These are some of the ways that natural properties of water creates an ideal therapeutic environment:
• Warm water provides a relaxing and soothing environment for aching joints and muscles.(26 C and 33 C).
• Water’s natural viscosity or resistance can be used for musclen strengthening and increasing rehabilitation progressions.
• Buoyancy allows for flotation and reduces the effects of gravity on injured or aching joints and muscles.(3-4).
• 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
Safety of aquatic exercise programs
Even though aqua therapy typically takes place in a fairly shallow pool, it is not risk free. To provide a safe environment for clients, 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: Open wounds, skin diseases,fever,urinary tract infections,chemical allergies,cardiac problems ,seizures , fear of water and severe hypertension/hypotension
Rehabilitation Applications In Arthritis and Related Disorders
The value of the aquatic environment has a longer
history in the management of arthritic diseases
than in almost any other disease group. The
losses that accompany chronic joint disease are
many: loss of strength, loss of joint mobility and stability,
and altimately loss of functional capacity. It has been
noted that rheumatoid patients as a group have lower than
expected aerobic capacity and physical performance, with
overall muscle strength 60% below that of age-matched
control subjects. These deficits respond promptly to
active rehabilitation, with well tailored strengthening
and endurance programs achieving gains in physical
performance levels in as brief a time as 6 weeks(5)
Long-term exercise regimens in rheumatoid patients
over many years have been well tolerated, with resultant
improvement in functional and other outcome measures (6).
A recent study of the cost-benefit in persons with
osteoarthritis demonstrated that individuals enrolled in an
Arthritis Foundation aquatics course significantly reduced
perceived disability related to arthritis and improved
perceived quality of life specific to physical health (7).
Because patients with arthritis have been shown to
have decreased endurance, these individuals should
participate in some form of aerobic exercise to enhance
their overall fitness. Studies have demonstrated the
benefits of aerobic exercise for many conditions, including
fibromyalgia pain (8-9-10).
Low-impact exercise has been shown to be more efficacious
than medications in the self-management of osteoarthritis (11).
Because the safest medium to reduce impact in the pool,
the incorporation of aquatic exercise and/or swimming
provides an advantageous alternative to manage arthritic
symptoms. This argument has been substantiated in two
studies of patient groups, with nonacute rheumatoid and
osteoarthritis participating in water exercise regimens. In
a study of rheumatoid patients, Danneskiold-Samsoe et
al. found markedly increased isometric and isokinetic muscle
strength of the quadriceps after only moderate training
in the pool. Other gains included an increase in aerobic
capacity, freedom of movement, and a higher degree of
independence in activities of daily living (12).
Postural sway, a factor associated with fall risk, has been
shown to decrease in patients undergoing a 6-week
aquatic exercise intervention (13).
Bunning et al. concluded that pool therapy was efficacious
and achieved high compliance for those with osteoarthritis
and that aquatic exercise should be the cornerstone of
active rehabilitation for severe arthritis. Patients who
participated in the study exhibited significant improvements
in aerobic capacity and physical activity level and were
less depressed than controls (14).
Ofﬂoading of body weight occurs as a function of immersion,
but the water depth chosen may be adjusted for the amount
of loading desired
Rehabilitative programs for speciﬁc joints may be more
effective as either closed or open kinetic chain programs.
Shallow-water vertical exercises generally approximate
closed chain exercise,albeit with reduced joint loading
because of the counterforce produced by buoyancy (15).
The hydrostatic effects of immersion, possibly combined
with temperature effects, have been shown to signiﬁcantly
improve dependent edema and subjective pain symptoms in
patients with venous varicosities (16).
Hydrotherapy and rehabilitation of patients with anterior
cruciate ligament disruption. Thomson et al conducted
a Cochrane systematic review on the effectiveness of
physiotherapist-led programs and interventions for
rehabilitation of anterior cruciate ligament (ACL), medial
collateral ligament (MCL) and meniscal injuries of the knee
in adults. The authors conducted searches on Cochrane
Musculoskeletal Injuries Group specialized database (17).
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 .(18)
Numerous studies of ﬁbromyalgic patients have
demonstrated reduction in pain, improvement in sleep
patterns, ﬁbromyalgia impact, mood state disorders, and
when compared with land-based exercise programs, the
aquatic groups typically showed faster and larger gains, with
longer post-study improvements (20-21).
Compare aquatic therapy 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.