FIRST LINE OF DEFENSE… NOT A LAST RESORT

BY Ande Baumann, P.T.

The pool has often been viewed as recreation, however, the therapeutic community has now established how aquatic physical therapy can help our patients achieve their therapeutic goals. The options in the water are unlimited. Neutral warm water can create an environment to promote overall relaxation, ease spastic muscles, and decrease hypertonicity, which allows greater range of motion in all joints.

Hydrostatic pressure and buoyancy principles of water help reduce pain in joints and soft tissue that the atmospheric pressure and land plays havoc with. It helps support the body in non-gravitational positions, which help flexibility and mobility in the areas being worked on. These principles also allow the patient to perform pre-gait activities and progression of more functional gait patterns that may not be able to be done on land.

Buoyancy of water also helps to provide trunk stabilization for low back, spinal problems, lack of muscle coordination and ataxia. Pressures of the water are always pushing inward and upward thereby aiding in coordination and balance deficits. Various positions in the water will affect the body in different ways to allow for an excellent means of strengthening progression and motor control. Enough endurance can be built so that the patient can progress to land based exercises that may have been painful, difficult, or impossible to perform before, due to post-operative constraints and weakness.

Movement in water helps to re-educate the body and allows it to move in ways that are easier and possibly eliminate pain. The water is an excellent medium to start neuromuscular re-education through pain free pathways of movement and to enhance independence in functional activities. Aquatic therapy affects the entire body at one time, which is great for the client who has the need to address multiple problem areas.

Sensory stimulation of the water helps increase awareness of affected body parts and helps desensitize the hypersensitive patient, which is a frequent problem associated with myofascial pain and fibromyalgia, as well as neurological or surgical patients.

Contraindications for the water are minimal, acute fever, severe cardiac complications, open wounds, isolation precautions and tracheostomy. Precautions should be taken for other concerns of incontinence, insufficient vital capacity, excessive vertigo, frequent ear infections, trouble with swallowing, visual field difficulties, and impaired sensation with accompanying neglect.

I have been performing physical therapy in the water since 1986, before it was actually called Aquatic Physical Therapy. On many occasions I receive referrals that are deemed as last resort or nothing else can be done. By this time, the patient’s stress and pain levels are at a peak and I hear these individuals say, “this is my last resort, I don’t know what else I can do.” We listen to the patients’ feelings about their situation and what could possibly have caused such complications. The therapist’s listening skills are tested because the cry for help is clearly heard in the voice.

Unnecessarily, many people delay aquatic physical therapy due to a lack of knowledge, not knowing how to swim, or just the fear of the water. Patients who undergo Aquatic Physical Therapy really do see progress and leave with an enhanced sense of accomplishment. Many misconceptions and delays in treatment progress can be avoided if warm water therapy is the first line of defense and not the last resort.

Originally published in Perspective – Birmingham, Alabama Chapter of the Case Management Society of America