Aquatic Therapy Use in Management of M.D.



Aquatic Therapy offers outstanding benefits for pain modulation; musculoskeletal rehabilitation, conditioning and training. It speeds the physical recovery process and improves mental well-being by enabling accelerated rehabilitation in cases of physical disability and musculoskeletal injury.

Aquatic physical therapy is one of the fastest growing areas of physical therapy and rehabilitation. The benefits have been recognized since ancient times when whirlpools and hot springs were used to promote healing and manage medical aliments.

What is Aquatic Therapy?

Aquatic therapy (AT) is the evidenced based and skilled practiced of physical therapy in an aquatic environment. AT includes but is not limited to treatment, rehab, prevention, health, wellness and fitness (conditioning) of clients in an aquatic environment. Conditions can be acute, transient or chronic.

Bates A., Hanson N. Aquatic Exercise Therapy. Philadelphia. W. B. Saunders & Company, 1996.

Tovin, B. J., Wolf, S. L., Greenfield, B. H., et al. Comparison of the effects of exercise in water and on land on the rehabilitation of patients with intra-articular anterior cruciate ligament reconstructions. Phys. Ther. 74 (8): 1994.

Hence, Aquatic Therapy exercise is the application of therapeutic exercise that occurs in the medium of water. The concept is simple. The results are real. Water provides buoyancy and viscosity. Buoyancy aids the patient’s movement while resisting gravity. Impact is minimal. Viscosity, the thickness of water, produces 3-dimensional resistance to all movement. Simply put, it’s a lot harder to exercise in water than onland while, at the same time, water substantially lowers the chances of further injury or pain. The temperature and pressure of the water also assist with circulation and relaxation of muscles. Compression forces created by the water helps to reduce edema, or swelling, in the tissue. Warm water increases circulation to the injured body part. (Allison TG, Reger WE. Comparison of responses of men to immersion in circulating water at 40.0 and 41.5 degrees C. Aviation Space Environ.Med 1998;69:845-850); Smith DW, Clarren SK, Harvey MA. Hyperthermia as possible teratogenic agent. J Pediatri 1978; 92:878-883)

The benefits Aquatic Therapy: Scientific Foundation and Applications in Clinical Rehabilitation

Numerous studies have reported the physiological benefits of aquatic therapy in the management of connective tissue injury and rehabilitationin humans. (Evans et. Al 1978, Gleim & Nicholas 1989, Migita et al 1994, Hotta et al 1995, Hall et al 1998, Shimizu et al., 1998; Shono et al., 2000, 2001 ab)

Chun Yang et al. have shown in research that mechanical tensile stimulation can significantly improve stem cell proliferation activity in the fascia connective tissue. This could be one mechanism for the effectiveness of manual therapy. Water has the capacity to exert three-dimensional (multi-planar) forces on objects moving in it. The eccentric component of these forces is highly effective in the rehabilitation process. Eccentric loading on muscle and tendon (connective tissue) physiologically enhances production (growth) and strength of these connective tissues through the process of mechano-transduction, microcirculation and growth differentiation factor/hormonal response (Khan KM et al 2009, Ohberg L et al 2004, Roig Met al 2009, Wood, T.O., et al.1988, Heinemeier KM et al 2007). This eccentric characteristic of water forces on a moving body can be very effective on the body “fascial net” which architecture design response according to the direction of strain loading applied to it (Chaitow, 1988; Blechschmidt, 1978). Connective tissue has the inherent ability that it’s a highly adaptive tissue. The fibroblast within the tissue is able to adjust its matrix remodeling capacity so the overall tissue architecture will response to the load demands (Kjaer et al.2009).


Exercise in water has the advantage of allowing a patient, unable to perform land-based exercises, to begin exercising sooner than otherwise possible. Aquatic therapy allows early weight bearing by unloading the weight and stress on the joints while providing supportive buoyancy to muscles. There is much evidence to show that lack of movement promotes the development of additional cross-links in fascial tissue which leads to a decrease in its elastic properties (schleip R. et al., Jarvinen et al, 2002, wood et al. 1988). Hence the need for reduce sedentary life style and early movement in rehabilitation.

In a resistant but supportive aquatic environment the patient’s muscular, proprioceptive and endurance activities can be increased according to their individual level of tolerance, confidence and healing. The body “fascial net is richly enervated with sensory nerves, including proprioceptive receptors, multimodal receptors and nociceptive nerve endings (Schleip R et. al. 2005 & 2003, Mense 1998 & 2010). Strong evidence exist to show that a an increase in local proprioception can significantly lower myofascial pain ( Moseley et al.

2008; Taimela et al.; 1999; Lambertz 2006). If the body “fascial net” is one of the most highly innervated sensory organs then this evidence could help prove the reports of pain relief or healing feeling from ancient baths were not just a myth but quite real.

Aquatic therapy offers patients a total exercise program that includes activities for cardiovascular conditioning, flexibility, strength, muscle endurance, muscular relaxation and post exercise recovery methods.

Aquatic therapy is an efficient and safe way to treat some diseases and maintain health and wellness.

Combining Aquatic Physical Therapy with standard, land-based therapy shortens the disability period.

Aquatic therapy is used in the treatment of:

  • Arthritis & fibomyalgia

  • Sports injuries

  • Burns

  • Spasticity

  • Ankylosing Spondylitis

  • Musculoskeletal/connective tissues disorders

  • Spinal cord injuries

  • Stroke with paralysis

  • Conditioning and wellness

  • Post exercise recovery

  • Obesity

From a historically sense, many ancient civilization used water (hot or cold) for comforting pain and treating diseases. Hippocrates prescribed hot springs for cure. Hot springs improve health by increasing circulation is a long accepted fact but there may be much more to this ancient belief.

There is an extensive scientific research base supporting aquatic therapy from within the basic science and clinical science literature. Because of its wide margin of therapeutic safety and clinical adaptability of its medium, “water”, aquatic therapy is a versatile and useful tool in the rehabilitation toolbox.


Dr. Wilbour Kelsick

Copyright 2010 © Clinical Director of MaxFit Movement Institute. Inc.

Medical IST Staff- Athletics Canada –Canadian Olympic Team


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