AQUATIC PHYSICAL THERAPY

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AQUATIC PHYSICAL THERAPY

• The Therapeutic Effects of Water
• Paula Godes, PT, DPT

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Overview

• History of Aquatic Exercise
• What is Aquatic Physical Therapy?
• Goals of Aquatic Physical Therapy
• Who Participates
• Hydrodynamics Application of Newtons Laws
• Law of Inertia
• Law of Acceleration
• Law of Action/Reaction
• Waters Viscosity and Frontal Resistance
• Center of Gravity
• Center of Buoyancy
• Hydrostatic Pressure
• Surface Tension
• Drag and Turbulence
• What is Your Goal? - Return to Running
• Our Program Present and Future

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History of Aquatic Exercise

• Early writings in the Old Testament Ascleius,
  Greek God of Medicine
• FDR Therapeutic spa made by Native Americans
• Early running rehab track athletes 1970s
• Research 1990s and increasing
• Boomers Leading the way for alternative
  exercises- over 10 million participated in
  aquatic exercise (Aquatic Exercise Assoc., 2000)

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What is Aquatic Physical Therapy?

• Aquatic Physical Therapy is the evidence-based
  and skilled practice of physical therapy in an
  aquatic environment by a physical therapist or by
  a physical therapist assistant who is under the
  direction and supervision of a physical
  therapist.  Aquatic Physical Therapy includes but
  is not limited to treatment, rehabilitation,
  prevention, health, wellness and fitness of
  patient/client populations in an aquatic
  environment with or without the use of assistive,
  adaptive, orthotic, protective, or supportive
  devices and equipment.
•  The buoyancy, support, accommodating resistance
  and other unique properties of the aquatic
  environment enhance interventions for
  patients/clients across the age span with
  musculoskeletal, neuromuscular,
  cardiovascular/pulmonary, and integumentary
  diseases, disorders, or conditions.

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What is the Difference?

• Aquatic physical therapy requires the skilled
  service of a PT and/or PTA which may include
• a) the clinical reasoning and decision making
  skills of a PT/PTA
•    b) the patient has impairments and/or
  disabilities which can be minimized or eliminated
  with aquatic physical therapy and
• c) the patient has potential for reaching new
  functional goals/outcomes to improve quality of
  life and ease burden of care.

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Specialized Training

• Is there a certification program for aquatic
  physical therapy?
• No however, the APTA Aquatic Physical Therapy
  Section is in the process of conducting a
  practice analysis to see if there is a need for a
  certification process.
• What education requirements are needed to
  specialize in Aquatic PT?
• Water safety, risk management, and an
  understanding of hydrodynamic principles and
  various techniques.
• Continuation Courses
• Aquatic Therapy Rehab Institute (ATRI)
  certification and membership

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Who Participates

• The Elderly those with painful, arthritic joints
• Obese or sedentary individuals
• Decreased function/weakness poor tolerance and
  endurance for land exercises
• Chronic illnesses/pain syndromes fibromyalgia,
  back pain
• Those recovering from illness or surgery
• Well-conditioned individuals or athletes Advance
  training using increased resistance of
  water/equipment

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Goals of Aquatic Physical Therapy

• Aquatic Physical Therapy interventions are
  designed to improve or maintain
• ?        function?        aerobic
  capacity/endurance conditioning?        balance,
  coordination and agility?        body mechanics
  and postural stabilization?       
  flexibility?        gait and locomotion?       
  muscle strength, power, and endurance

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HYDRODYNAMICSLaw of Inertia

• An object will remain at rest or in motion with
  constant velocity unless acted on by a net
  external force
• Total Body Inertia requires more muscular effort
  to start, stop or change movement.
• Waters Inertia increases resistance
• Add travel through the water more effort

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Law of Acceleration

• The reaction of a body as measured by its
  acceleration is proportional to the force
  applied, and inversely proportional to its mass.
• In other words, if you use more muscular effort,
  you accelerate (increase) the force.
• Note Going faster will increase intensity, but
  is normally not recommended in a therapeutic
  environment lose ROM- use force instead of
  speed to increase intensity
• The greater the body mass, the more force it
  takes to move that mass

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Law of Action/Reaction

• For every action, there is an equal
  and opposite reaction
• Viscosity of the water with arms and legs can be
  used to assist or impede movement
• Actions of the arms and legs working with each
  other (assisting) or in opposition (impeding)
• Example jogging forward with front crawl arms
  (assisting), less intense than jogging forward
  pushing arms forward (impeding)

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Waters Viscosity

• Friction between molecules of a
  liquid cause them to adhere to each other
  (cohesion) or to a submerged body (adhesion)
• Resistance surrounds the body and affects every
  movement in every direction
• Larger surface area MORE resistance
• Smaller surface area LESS resistance

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Increasing Intensity

• Its NOT about speed!
• Use inertia, acceleration, action/reaction,
  frontal surface area, hand positions, levers, to
  increase intensity much more effective
• Use training techniques that maintain ROM against
  the waters resistance
• Most movements done in the water involve only
  concentric muscular contractions - muscle
  soreness is minimal

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Center of Gravity

• Center of a bodys mass
• Position of body parts determine position of
  center of gravity
• Widen base of support stabilizes the center of
  gravity
• Men torso near the chest
• Women torso nearer to pelvic girdle

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Center of Buoyancy

• Center of the volume of the
  body displacing the water
• Affects movement when submerged
• Located in the chest area (lungs, air pockets)
• Impacted by volume of air (inhaling or exhaling),
  and by the density of the body
• Muscle vs. fat Buoyant bodies have more fat
• Buoyancy decreases effects of gravity-reduces
  weight bearing/compression of joints
• In water up to neck 90 reduction
• In water to waist 50 reduction
• Joint capsules OPEN when submerged greater
  flexibility

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Buoyancy

• Force of buoyancy vertically
  upward-movement toward the surface of the
  pool - buoyancy assisted
• Movement of a buoyant object toward the pool
  bottom buoyancy resisted
• Floating movement on the surface of the water
  buoyancy supported
• Biceps curls with foam dumbbells concentric
  triceps (buoyancy resisted) eccentric triceps
  (buoyancy assisted)

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Hydrostatic Pressure

• Pressure increases with depth
• Affects on body
• Increased blood flow from 1.8 to 4.1 mL/min/100g
  of tissue increased oxygen delivery and
  circulatory force
  
  
  
• Improvement with dependent edema reduced
  swelling
• Renal blood flow increased by 10 - increased
  urinary output/waste excretion

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Surface Tension

• Force exerted between the
  surface molecules of a liquid
• Caution with arm patterns that move above and
  below the waters surface
• No snapping out of the water- especially
  careful w/ buoyant equipment

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Drag Turbulence

• Drag is the force that you feel that opposes your
  movements in the water
• Drag affected by frontal surface area, velocity
  and shape of object
• Submerged movement resisted in all planes of
  movement and in all directions of movement by the
  waters viscosity and drag properties

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Why Deep Water Running?

• The most biomechanically specific form of cross
  training for the runner
• Alternative training during an injury excellent
  for stress fractures or foot, ankle, or knee
  injuries for whom running on land is
  contraindicated no impact
• Provides a strengthening component land running
  doesnt
• 800 times denser than air and provides up to 12
  times the resistance
• Regular runners burn about eight calories a
  minute, aqua-runners burn 11.5 in the same time
  (with the same intensity)
• Scientific evidence has demonstrated that deep
  water running results in a sufficient training
  response in order to affect fitness improvement.
  This has been further documented by studies that
  have shown maintenance of exercise and
  performance in even competitive distance runners
  while training strictly with deep water running
  for periods up to six weeks long. (Dr. Robert
  Wilder, Director of Sports Rehab- UVA)
• For Soldiers, a quicker return to running (TBD)
  

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Aquatic Running Form

• Running in deep water is performed with the body
  in a 5 degree forward tilt. This bend should
  occur at the hips, nor from the spine. The
  biomechanical movement patter of water running
  resembles that used on land.
• The head is held comfortably out of the water,
  facing forward avoid the forward head/shoulder
  posturing.
• Maintain a neutral spine. Always use a buoyancy
  belt to maintain form.
• The arm action is the same as for land running,
  with the primary movement occurring at the
  shoulder and with the hands relaxed - slight
  scapula depression and retraction
• Hip flexion should reach approximately 60-80
  degrees at the same time the knees flex or
  extend.
• Ankle movements should include both dorsi and
  plantar flexion.

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Deep Water Alignment Mistakes

• Leaning forward
• Snapping the knee when kicking
• Exaggerated lumbar hyperextension
• Cervical hyperextension (looking up)
• Hyperextending elbows and knees
• Movements without precision
• Overflexing the knee joint
• Neglecting hand positioning
• Emphasize ADIM for pelvic alignment

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Instruction Pearls

• Find out who doesnt swim
• Ensure proper amount of buoyant equipment is used
  to suspend with head above water
• Emphasize working at own pace use time, not
  group counts
• Check pain level before activity. Emphasize
  aquatic therapy should not increase pain.
• Stretching session afterwards great time to
  increase ROM!

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Our ProgramGoals and Future Direction

• Our Capacity
• Tuesday/Thursday 0700-0800
• 10 scheduled slots Acute walk-ins (10-12 avg.)
• Must be evaluated by DeWitt Physical Therapist
  and recommended for aquatic therapy Max 8
  sessions
• MWR Benyaurd Indoor Pool
• MWR lifeguards one therapist
• Future SPRING 2011?
• Separate therapy pool 1st floor
• Daily therapy sessions group and individual
• Increased staff 1-2 Therapists 2-3 PTAs
• Leader in Aquatic Research

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AQUATIC ARMY STRONG
Who says its easy?