PRORehab Library

Aquatic Therapy for Athletes

Is your child’s stress fracture keeping them sidelined? Is your team bored with their training program? Did you just complete a marathon and now you are looking for some creative cross training to do in the off-season? What about exercise in the water (aka aquatic therapy)? Aquatic therapy can be used by itself or in conjunction with other forms of rehabilitation or conditioning to meet the needs and goals of your athlete. It can minimize injury and reduce recovery time.
There are many benefits of aquatic therapy. The benefits include, but are not limited to: buoyancy, viscosity, and hydrostatic pressure.
The first benefit of exercise in the water is buoyancy. Buoyancy equals an upward force generated by the volume of water displaced (Archimedes’ principle). The amount of your body’s weight that you support is reduced in the water. When you are submerged in water to your clavicles you are bearing approximately 10% of your weight, submerged to xiphoid process is approximately 25% of your weight, to waist is approximately 50% of your weight. It allows for the initiation of closed-chain exercises, strengthening, and conditioning when weight bearing is limited or restricted. For example, if a football player is coming out of an ankle cast and was told to begin weight bearing as tolerated, then a pool is a good environment to begin gait-training activities. Aquatics provides the athlete with opportunity to immediately initiate rehabilitation in a safe “unloaded” environment.
A second benefit of exercise in the pool is the viscosity. Viscosity is the magnitude of internal friction specific to the fluid. Water presents much resistance to movement. There are several methods of increasing that resistance in the water. One is the speed of movement. The faster you perform an exercise in the water, the higher the resistance of the moving part against the water. Increasing the surface area of resistance also increases the force. If you wear webbed gloves during arm motions it increases the challenge of the exercise. Another method of increasing force through the water is simply by adding weight or resistance tubing to the moving lever.
Hydrostatic Pressure is another benefit of aquatic therapy, specifically for the injured athlete. Pascal’s Law states that “fluid pressure is exerted equally on all surfaces of an immersed body at rest at a given depth.” Pressure increases as depth increases. This pressure gradient can be used therapeutically by reducing edema in the lower extremities and offsetting of blood pooling in lower extremities (which can lead to muscle soreness following a workout). An athlete with a sprained ankle could stand in a pool on the uninjured leg and perform the ankle alphabet with the injured ankle. The hydrostatic pressure of the water would help reduce edema in the ankle, thus helping to increase ankle range of motion.
I cannot cover all the benefits of water exercise without listing the reasons not to incorporate water exercise. The contraindications are: intense fear of water, open wounds, contagious skin conditions, soft tissue infections, urinary tract infections, upper respiratory infections, fever over 100 degrees, allergies to pool chemicals (i.e. Bromine, chlorine), unmanaged cardiac problems, uncontrollable seizures, questionable continence, and low vital lung capacity (less than 1500 ml). If athlete has none of the contraindications listed, than water exercise can be incorporated into a training program. Exercise should be monitored closely until the athlete feels confident with their surrounding and has knowledge and ability to perform the exercise program. Care and water safety should not be overlooked.
Water can be the ideal medium to perform functional and sports-specific activities when returning from injury. The buoyancy “unloads” joints which in effect reduces pain in the injured joint. Water allows the athlete to be in a controlled, supervised environment. The viscosity provides a slow motion, multi-dimensional resistive environment for retraining and proprioceptive (awareness of position and movement of body) feedback. Skills can be initiated early on, increasing speed, amplitude, and extents in range as able to until it recreates functional activity. The hydrostatic pressure reduces swelling and subsequent soreness from exercise. Running and plyometrics can be done with all the benefits without the pesky side effect of joint pain. Go to the pool, have fun, and be creative!

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