Aquatic Therapy Gains Steam

December 2011

Kathleen Kristoff


Public speaking may statistically top the list of “the most common fears,” but a physical therapist working with older adults who have balance issues knows that fear of falling can be stronger than any other worry. Certainly, it’s easy to understand the patients’ concerns; after all, falling can cause injuries leading to complications, additional health problems, and even death.
Fear of Falling
The reasons why aging individuals fall are varied: decreased range of motion, balance, and gait patterns can all be culprits. And so can medical conditions such as arthritis and degenerative joint disease.

Unfortunately, traditional physical and occupational therapies do not work as well as they would if the patient were not terrified of falling. For instance, if a 70-year-old woman with balance issues and a history of falling is expected to complete physical or occupational therapy exercises, she will have to be supported the entire time, lest she fall or stop working because she’s too frightened.

Most likely, she’ll be relegated to performing rehabilitative exercises while sitting or lying down, which will limit her progress. More than likely, the exercises will be passive, static, and short in duration.
Attitude Adjuster
So what is the answer for this type of patient? In the experience of some rehabilitation practitioners, it’s aquatic therapy
Attitude Adjuster
So what is the answer for this type of patient? In the experience of some rehabilitation practitioners, it’s aquatic therapy.

Aquatic therapy isn’t a new concept in rehabilitation, and it’s gaining momentum year after year.

Warm-water environments were prescribed centuries ago to ease ailments like joint pain and, ironically, they’re still prescribed today. But the soothing temperature of the water isn’t the only benefit to investing in a high-end therapy pool with underwater treadmill and variable floor depths.


By far, one of the greatest advantages to offering patients aquatic therapy is the way it changes patients’ attitudes.


Often, when patients realize they are surrounded and buoyed by water, they tend to put forth a better amount of effort than they would during land-based rehabilitation. Thus they wind up physically stronger and more secure.

The innate scientific properties of water are without a doubt a physical or occupational therapist’s best friend when working with patients with balance challenges.


In an aquatic environment, the body is supported up to 90 percent, depending upon the height of the water, which is why a therapy pool with an adjustable floor is best. This relaxes everyone involved, as falling becomes nearly impossible.
Multiple Benefits
Physical or occupational therapy in a pool has a plethora of other benefits as well, including: increased muscle relaxation, decreased muscle spasms, increased ease of joint movement, decreased sensitivity, increased muscle strength and endurance, increased peripheral circulation, decreased pain, improved body awarenessand balance, and improved proximal trunk stability.


Some patients find it so positive that they continue exercising in the pool for pleasure and health long after their therapy has ended.

While aquatic therapy works on a wide variety of patients, it is especially useful on those with limited range of motion, decreased daily living activities, impaired trunk stability, postural abnormalities, decreased strength, decreased balance, impaired mobility, pain, edema, and gait abnormalities.

However, aquatics may not be suitable for those who have had cardiac failure, have open wounds or infectious diseases, are extremely weak (due to system changes), are incontinent, have abnormal blood pressure levels, or have low vital lung capacities.
Reward Is In The Results
There’s little doubt that adopting aquatic therapy as part of a clinic or facility’s offerings leads to more confident patients who are apt to come back for sessions and work hard to achieve success. When an 85-year-old man with a history of falls starts rehabbing using aquatic therapy techniques, he is able to take traditional physical and/or occupational exercises to a whole new level.

This leads to faster healing, a renewed sense of freedom, and better results for him on land. And from a physical or occupational therapist’s point of view, watching the transformation of an adult from fearful to secure is one of the most highly rewarding aspects of the job.

Kathleen Kristoff, OTR/L, CHT, is a director of rehabilitation services at an outpatient rehabilitation center in Ohio. Kristoff has been nationally recognized as an expert in aquatic therapy methodologies and has been asked to speak at many conferences as a result.