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After completion of this chapter, the physical therapist should be able to do the following:

  • Explain the principles of buoyancy and specific gravity and the role they have in the aquatic environment.

  • Identify and describe the three major resistive forces at work in the aquatic environment.

  • Apply the principles of buoyancy and resistive forces to exercise prescription and progression.

  • Contrast the advantages and disadvantages of aquatic therapy in relation to traditional land-based exercise.

  • Identify and describe techniques of aquatic therapy for the upper extremity, lower extremity, and trunk.

  • Select and utilize various types of equipment for aquatic therapy.

  • Incorporate functional, work-, and sport-specific movements and exercises performed in the aquatic environment into rehabilitation.

  • Understand and describe the necessity for transition from the aquatic environment to the land environment.

In recent years, there has been widespread interest in aquatic therapy. It has rapidly become a popular rehabilitation technique for treatment of a variety of patient/client populations. This newfound interest has sparked numerous research efforts to evaluate the effectiveness of aquatic therapy as a therapeutic intervention. Current research shows aquatic therapy to be beneficial in the treatment of everything from orthopedic injuries to spinal cord damage, chronic pain, cerebral palsy, multiple sclerosis, and many other conditions, making it useful in a variety of settings.29,38 It is also gaining acceptance as a preventative maintenance tool to facilitate overall fitness, cross-training, and sport-specific skills for healthy athletes.23,33,34 General conditioning, strength, and a wide variety of movement skills can all be enhanced by aquatic therapy.19,43,48,54

The use of water as a part of healing techniques has been traced back through history to as early as 2400 bc, but it was not until the late 19th century that more traditional types of aquatic therapy came into existence.4,24 The development of the Hubbard style whirlpool tank in 1820 sparked the initiation of present-day therapeutic use of water by allowing aquatic therapy to be conducted in a highly controlled clinical setting.8 Loeman and Roen took this a step farther in 1824 and stimulated interest in use of an actual pool or what we now call aquatic therapy. Only recently, however, has water come into its own as a therapeutic exercise medium used for a wide variety of diagnoses and dysfunctions.41

Aquatic therapy is believed to be beneficial primarily because it decreases joint compression forces. The perception of weightlessness experienced in the water assists in decreasing joint pain and eliminating or drastically reducing the body’s protective muscular spasm and pain that can carry over into the patient’s daily functional activities.54,56 Although many patients perceive greater ease of movement in the aquatic environment as compared to movement on land, the research shows that aquatic therapy does ...

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