CHIROPRACTIC CARE: Aquatic Therapy (EXERCISES IN WATER)

Aquatic Therapy in Rehabilitation

•Useful tool to facilitate training & fitness

•Movement skill& strength can be enhanced

•Effects

• joint compression

•Reduces muscular guarding

•Useful in improving movement and fitness

•Basic Concepts as Land-based Rehab

•Warm-up

•Strengthening/mobility activities

•Endurance/cardiovascular Cool down/stretch

Goals

•Specific Goals:

•Facilitate ROM

•Initiate resistance training

•Facilitate weight-bearing activities

•Enhance delivery of manual techniques

•Provide 3-dimensional access to patient

•Facilitate cardiovascular fitness

•Initiate functional activity

•Minimize risk of injury/re-injury during rehab

•Enhance patient relaxation

Precautions& Contraindications

•Precautions

•Fear of water

•Neurologic disorders

•Seizures 

•Cardiac dysfunction

•Small open wounds & intravenous lines

•Contraindications

•Onset of cardiac failure & unstable angina

•Respiratory dysfunction

•Severe peripheral vascular disease

•Danger of bleeding or hemorrhage

•Severe kidney disease

•Open wounds,skin infections

•Uncontrollable bowel/bladder

•Water &airborne infections or diseases

•Uncontrolled seizures

Advantages& Benefits

•Buoyancy allows active exercise while providing a sense of security and minimizing discomfort

•Water  environment in which more can be accomplished than on land

•Useful in early stages of rehabilitation

•Provides for earlier movement due to ¯ compressive forces

•Supportive environment – allows for extra time to control movement – proprioception enhancement

•Turbulence functions as a destabilizer & as a tactile sensory stimulus

•Provides gradual transition from non-WB to full  WB

•Psychologically – may allow for increased confidence due to increased ability of function allowed by water

•Strengthening & muscle re-education

•Strength gains are dependent on effort put forth by athlete

•Energy expenditure may be 

­•Must perform activity & maintain stability of body within the water

•Cardiovascular maintenance

Disadvantages

•Cost

•Building & maintaining a rehabilitation pool

•Space &personnel 

•Thermoregulation

•Impact on core body temperature

•May impact tolerance for participation in heat

•Contraindications involved with injuries& potential of open wound

•Additional contraindications

•Fear of water,fever, urinary tract infection, allergies to pool chemicals, cardiac dysfunction or uncontrolled seizures

•If lacking inability to stabilize body, aquatic training can be challenging

•Facility must have certain characteristics

•Should be at least 10 ft. x 12 ft.

•Adequate access(either above or below ground pool)

•Shallow &deep areas to perform various exercises

•Flat pool bottom with marked gradients - optional

•Adequate temperature (79°-82°)

•Ancillaries

•Prefabricated pools with treadmill or current producing device

•Pool toys –limited by imagination (gloves, hand paddles, belts, kick boards)Clothing & attire

Equipment

•Safety equipment – 

•Exercise equipment –

•Assistive Devices – flotation devices

•Resistive devices – paddles,water shoes, webbed gloves

Aquatic Techniques

•Program can be designed to have active assistive movements & progress to strengthening

•Can perform exercises in various positions including:

•Supine, prone,side-lying, seated, vertical

•Things to consider when performing aquatic techniques:

•Type of injury/surgery

•Treatment protocols if appropriate

•Results/muscle imbalances found in evaluation

•Goals/expected return to activity

•Program design (similar to land-based programs)

•Warm-up

•Strengthening/mobility activities

•Endurance/cardiovascular

•Cool down/stretch

Spine Dysfunction

•Initial Level

•Instruct athlete on neutral position in partial squat with back against wall

•Wall will provide feedback to monitor ability to maintain position

•Progression of upper/lower extremity activity can be incorporated with stabilization exercises

•If dealing with sciatica-type symptoms, deep water traction may be beneficial

•Work on normalization of gait pattern and increasing ability to bear weight (performed in deep end)

•Increasing pelvic mobility through stretching

•Intermediate Level

•Move athlete away from wall

•Incorporate equipment to simulate pulling/pushing motions

•Can also perform activities that incorporate single leg stance and lunging while challenging dynamic stabilization of core

•Supine and prone activity can also be utilized to train core

•Advanced Level

•Must be sure to incorporate activities that  mirror challenges of sport and provide higher level of trunk stabilization

•Train bilateral activity –integrate opposite movement patterns

•Athlete should be integrated back to training on land

•Water does not allow for normal speeds and forces during sports specific activities

Lower Extremity Injuries

•Initial Level

•Goal - restore normal motion & early strengthening

•Restore normal gait patterns

•Can work on active joint motion (hip, knee, ankle)

•Utilize cuffs,noodles, or kick boards under foot will assist with increasing motion

•Incorporate conditioning & balance activities

•Utilize good postural mechanics while challenging balance/neuromuscular control

•Deep-water activities allows for conditioning & cross-training

•It also provides an opportunity for non-weight bearing secondary to injury

•Incorporate of supine activities

•Resistance against uninvolved leg will also allow for strengthening of injured extremity

•Intermediate Level

•Challenge athlete with weights& flotation devices

•Be aware if you need to use proximal or distal resistance

•Utilize straight & diagonal plane activities

•Balance training

•Standing on cuff, noodle, uneven surfaces

•Deep water tethering for running/sprinting

•Continue integrating supine &prone exercises as athlete’s strength & ability ­Integrate sports specific activity & jumping progression

•Final Level

•Athlete should be engaged in high level strengthening & conditioning

•Program should compliment land-based program

•Decrease use of floatation devices, alter use of buoyancy cuffs (minus floatation belt)

•Endurance training in aquatic environment is a good alternative for athlete’s conditioning program

•May be useful in preventing recurrence of injury

Conclusions

•Should not be exclusive treatment option for athlete

•Many physical & psychological benefits during early stages of rehabilitation

•Sports specific training – utilize land &water based training to achieve goals Must be sure to engage in activity at “normal” speeds and force levels prior to return to play