1. 13
Aquatic Therapeutic Exercise

2. Benefits and Purpose of Aquatic Therex
Exercise sometimes possible sooner in water than on dry land
Non weight bearing
Offers total exercise program: cardiovascular conditioning, flexibility, strength, muscular endurance

3. Specific Gravity Also called relative density
Ratio of an object’s weight to the weight of an equal volume of water
Specific gravity of water = 1
For human body, depends on lean and fat mass and distribution of body fat
Average specific gravity for body =

4. Archimedes principle: A body partially or fully immersed in a fluid will experience an upward thrust of that fluid that is equal to the weight of the fluid the body displaces.

5. Buoyancy Archimedes principle
A body with a specific gravity of less than 1 will float because weight of water displaced is less than weight of body
If body has specific gravity of 0.95, 95% of body will be submerged and 5% will float

6. Center of Buoyancy
The center of gravity of the displaced fluid and the point at which the buoyant force acts on the body
When in equilibrium, the center of buoyancy and the center of gravity are in vertical alignment with each other and the body is balanced

7. Hydrodynamics Viscosity
The resistance to movement within a fluid that is caused by the friction of the fluid’s molecules
Influenced by cohesion, adhesion, surface tension
(continued)

8. Hydrodynamics
Drag: the water’s resistance to a body that is moving through it
Form drag
Wave drag
Frictional drag

9. Hydrostatic Pressure
Pascal’s law: Pressure from a fluid is exerted equally on all surfaces of an immersed object at any given depth
The more deeply the object is immersed, the greater the pressure
For every foot of submersion, water pressure increases by 0.43 psi
Positive impact on edema

10. Pascal’s Law
Reprinted from Bates and Hanson 1996.

11. Weight Bearing in Water
The more deeply the body is submerged, the less weight is borne by the lower extremities.
Females’ center of gravity is lower than males’: affects percentage of body weight borne at different depths.
The faster a person walks in the water, the higher the weight-bearing percentages.

12. Weight Bearing in Water
Reprinted from Harrison, Hillman, and Bulstrode 1992.

13. Aquatic Equipment Safety equipment
Assistive devices: help stabilize body, maintain buoyancy, assist in motion
Resistive devices: used to increase muscle strength/endurance; increase surface area, require speed, add buoyancy or weight
Cardiovascular devices

14. Indications for Aquatic Therex
Pain, edema, muscle spasm, loss of motion, weakness, limited endurance
Restricted weight-bearing status
Maintaining cardiovascular conditioning or normal status of uninvolved extremities

15. Advantages Can be performed even if weight bearing is restricted
Warmth of water can relax muscles, relieve pain
Buoyancy reduces joint compressive forces
Reduces weight bearing while allowing muscles to continue to function properly in the gait sequence

16. Advantages Can promote body awareness and balance
Can relieve or reduce pain due to immobilization or edema
Can be used early in rehabilitation program, helping to prevent deconditioning

17. Precautions for Aquatic Therex
Fear of the water
Medications
Ear infections
Conditions such as diabetes, cardiovascular disease, seizure disorders
Never allow patient in pool unattended

18. Contraindications for Aquatic Therex
Contagious infection
Severe cold or flu
Urinary tract infection
Temperature of 100° F or more
Open wounds

19. Application of Aquatic Principles
Hydrostatic pressure: more advantageous to exercise swollen extremity in deep water
Greater resistance achieved through
longer lever arm, straighter extremity
increased speed
moving object at surface of water or with increased surface area

20. Aquatic Exercise Progression
Early
Use buoyancy equipment for increased range of motion.
Do gait training in deep water.
Use resistance exercises without equipment.
(continued)

21. Aquatic Exercise Progression
Mid
Emphasize restoration of muscle strength and endurance.
Use drag to increase resistance.
Add resistive equipment.
Increase reps and sets.
(continued)

22. Aquatic Exercise Progression
Advanced
Focus on restoration of ABCs of proprioception
Gait training more intense and varied
Hopping, jumping, etc.
Eyes open, closed.
Increased intensity for strength
(continued)

23. Aquatic Exercise Progression
End phase
Mimicking skills and demands of sport
Aggressive coordination, agility, speed activities
Plyometrics

24. Benefits of Deep-Water Exercise
No weight bearing and no impact forces
Can help maintain cardiovascular fitness and strength
Forces of gravity on a submersed body are minimal
Exercises essentially concentric

25. Correct Vertical Alignment

26. Correct Position for Deep-Water Running

27. Refraction of Light

28. Determining Depth of Water
Patient’s confidence in the water
Patient’s weight-bearing status
Goals of the exercise