May 20 2020

Hydrotherapy is a common form of exercise rehabilitation utilised by physiotherapists. Here at Mitcham Rehab we have a fantastic SwimEx pool at our disposal. The SwimEx pool has features including an adjustable current to provide resistance for strength and cardiovascular exercise.

Who’s it For?

Clients attending hydrotherapy sessions at Mitcham Rehab are most commonly undertaking rehabilitation for lower limb ostoearthtritis (hip and knee), lower back pain, shoulder conditions or following orthopaedic surgery.  Clients who have sustained an injury requiring altered weight bearing to facilitate healing (e.g. lower limb sporting injuries or stress fractures) also frequently use hydrotherapy as a means of keeping active during the recovery period.

Does it Work?

The majority of research into the effectiveness of hydrotherapy in musculoskeletal conditions focuses on osteoarthritis of the knee and hip. A Cochrane review published in 2016 analysed the evidence available for the effect of aquatic exercise for people with osteoarthritis of the knee and hip. The review of  published research in this area found moderate quality evidence that people with hip and knee osteoarthritis achieve improvements in their quality of life, and reductions of pain and disability from doing aquatic exercise. Considering the high burden of osteoarthritis for patients, who experience pain, tenderness and limited movement in their affected joints, the ease of exercise in warm water sounds pretty good.

Interestingly, a review published in 2017 in the Archives of Physical Medicine and Rehabilitation looking at the effectiveness of aquatic exercise for increasing lower limb strength in patients with musculoskeletal conditions found limited effect. One of the limitations discussed in the paper was that the application of resistance in the aquatic exercise may have been insufficient to provide a strength benefit. Further suggestion was made that trying to increase resistance could possibly yield better results. We are hopeful that as our SwimEx pool allows for graded increase in exercise resistance it may provide those strength benefits. The resultant reduction in pain and increased quality of life from hydrotherapy may also lead to better implementation of a land based strength program in conjunction with hydrotherapy.

Crank it up!

The idea of upping the resistance during hydrotherapy sessions was championed in a recent episode of the British Journal of Sports Medicine’s podcast by Dr. Ben Waller, who conducts research on optimising the prescription of aquatic exercise. Dr. Waller’s sentiments were that aquatic exercise could be performed harder and faster to make the most of the water based environment, rather than just doing land based exercise in the pool. According to Dr. Waller, the drag resistance provided by the water can be optimised by increasing the speed of movement or by using equipment that increases the surface area of the body part being moved through the water e.g. a paddle, boot or flipper. The key to achieving those elusive strength benefits could be to push harder with the exercise!

Buoyancy during aquatic exercise provides a commonly recognised benefit of reducing load on joints. In addition, Dr. Waller also suggested that performing active movements in the water can improve proprioception (joint position sense). The combination of buoyancy in water and the effect of gravity trains postural control.

Whilst it has been proposed that the hydrostatic pressure of the water improves joint stability, Dr. Waller suggested that this is unlikely. Improved control of joints during aquatic exercise is more likely a result of decreased weight bearing allowing weak muscles to better control joint movements.

Take home message

Overall Dr. Waller’s opinion was that despite land based and aquatic exercise being different therapies, results in the treatment of early or late osteoarthritis and post operative joint replacement rehabilitation can be just as good in isolation, or used together as part of a combined program.

Here at Mitcham Rehab we are firm believers in the adage that the best exercise program is the one that gets done, so personal preference counts for a lot.

If you’re interested in an assessment or checking out our facilities to see if aquatic exercise can work for you, by all means get in touch, we’d love to help!

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