Make a Splash: Introduction to Aquatic Therapy

Unlike recreational swimming, aquatic therapy is goal-directed and tailored to each patient’s condition and limitations. 

Aquatic therapy offers a unique and supportive environment for individuals recovering from injury, dealing with chronic conditions, or wanting to improve their functional mobility. Using the characteristics of water — buoyancy, resistance, and hydrostatic pressure — physical therapists can help patients perform movements that are usually difficult or painful on land. 

This approach is especially useful for people with limited mobility, joint pain, or neurological challenges. 

This article explores aquatic therapy, including its principles, benefits, and applications in physical therapy practice. It also outlines how therapists can integrate water-based therapy into treatment plans for a wide range of patients. 

Related CE course: Introduction to Aquatic Therapy

What is aquatic therapy? 

Aquatic therapy, also referred to as hydrotherapy or water-based rehabilitation, involves therapeutic exercises performed in a pool under the supervision of a trained clinician. The water is typically warm, which provides support, reduces impact on joints, and promotes circulation. 

Unlike recreational swimming, aquatic therapy is goal-directed and tailored to each patient’s condition and limitations. It can include stretching, walking, resistance exercises, balance activities, or cardiovascular training — all adapted to the water environment. 

Key principles of aquatic therapy 

Aquatic therapy is effective thanks to the physical properties of water that create a safe and supportive setting for movement. These include: 

1. Buoyancy 

• Reduces the effects of gravity, allowing patients to move with less effort.
• Supports weakened muscles and joints. 
• Makes it easier to perform weight-bearing exercises with reduced discomfort. 

2. Resistance 

• Water provides gentle, uniform resistance in all directions. 
• Strengthens muscles without the need for weights. 
• Can be adjusted by changing speed, direction, or using aquatic equipment.

3. Hydrostatic pressure 

• Exerts gentle pressure on the body, promoting circulation.
• Helps reduce swelling and edema.
• Supports postural stability and breathing.

4. Temperature 

• Pools are typically maintained at 88–94°F to relax muscles.
• Warm water promotes blood flow and reduces muscle spasms.
• Comfortable temperatures help increase participation in movement.

Benefits of aquatic therapy 

Water-based therapy offers many advantages, especially for individuals who may have difficulty tolerating traditional land-based exercise. 

Benefits of aquatic therapy include: 

1. Less joint stress 

• Ideal for patients with arthritis, joint replacements, or chronic pain.
• Buoyancy minimizes joint compression.
• Allows earlier initiation of movement after surgery or injury.

2. Improved balance and coordination 

• The water’s support allows for safe balance training.
• Reduces fear of falling during movement tasks.
• Encourages patients to challenge their stability in a low-risk setting.

3. Increased range of motion 

• Warm water and buoyancy promote gentle stretching.
• Helps patients regain mobility in stiff or painful joints.
• Reduces joint stiffness common in chronic conditions.

4. Cardiovascular and muscle conditioning 

• Walking or jogging in water builds endurance.
• Resistance strengthens muscles without excessive load.
• Pool-based aerobic exercise may be better tolerated by patients with joint pain.

5. Support for neurological recovery 

• Water provides sensory input and postural support.
• Beneficial for patients with stroke, MS, Parkinson’s disease, and spinal cord injuries.
• Encourages movement in those with impaired motor control or spasticity.

6. Psychological benefits 

• Many patients feel more relaxed and confident in the water.
• The soothing environment can help lower stress and anxiety.
• Group aquatic classes can encourage social interaction and motivation.

Related CE course: Aquatic Upper Extremity Training, An Integrated Approach

Indications for aquatic therapy 

Aquatic therapy can be used across many patient populations and conditions. It is often applied in: 

• Orthopedic rehabilitation (e.g., after surgery, joint replacement, or fracture)
• Chronic pain conditions (e.g., fibromyalgia, arthritis, back pain)
• Neurological disorders (e.g., stroke, multiple sclerosis, cerebral palsy)
• Sports injury recovery
• Balance and fall prevention
• Pediatric therapy for developmental delays
• Deconditioning from illness or prolonged inactivity
• Postpartum rehabilitation or pelvic floor therapy

Contraindications and precautions 

While aquatic therapy is safe for most people, there are certain cases where caution is needed or therapy may not be appropriate. 

Contraindications 

• Open wounds or active infections
• Uncontrolled seizures
• Severe incontinence
• Severe cardiac conditions
• Unstable vital signs
• Contagious skin disorders

Precautions 

• Fear of water or limited swimming ability (can be addressed with support)
• Cognitive impairments requiring close supervision
• Skin sensitivities to pool chemicals
• Need for assistance entering or exiting the pool
• Respiratory issues that may be affected by humidity

Role of the physical therapist 

Physical therapists should assess each patient’s condition and goals before recommending aquatic therapy. They can develop a customized plan based on: 

• Functional limitations
• Pain levels
• Mobility needs
• Safety concerns
• Desired outcomes

Therapists guide patients through aquatic exercises, monitor responses, and make adjustments based on how the patient feels and performs in the water. Collaboration with the rest of the care team makes sure that aquatic therapy complements other ongoing interventions (e.g. exercise plans, manual therapy, etc.). 

Integrating aquatic therapy into treatment plans 

Water-based therapy can be used as a main or complementary intervention depending on the patient’s needs. In many cases, it helps bridge the gap between limited movement and full participation in land-based therapy. 

Transitioning between settings 

• Patients may begin in water when weight-bearing is limited and progress to land-based exercises over time.
• Therapists can incorporate similar movement patterns across both environments.
• Moving between settings can support smoother recovery and lower the chance for setbacks.

Combining modalities 

• Aquatic therapy can be paired with manual therapy, neuromuscular re-education, or home exercise programs.
• Coordination between land and water sessions supports continuity.
• Documenting progress in both settings allows therapists to adapt strategies based on patient performance.

Special considerations for equipment and setup 

To make the most out of aquatic therapy clinics and facilities could use specialized tools and environmental modifications. These may include: 

Common equipment 

• Aqua dumbbells, paddles, and resistance bands
• Kickboards and flotation belts
• Underwater treadmills and resistance jets
• Pool lifts or ramps for safe access

Environmental setup 

• Maintain proper water temperature and chemical balance
• Make sure there is proper supervision and safety protocols in place
• Provide privacy when needed for sensitive conditions

Conclusion 

Aquatic therapy provides a safe and supportive setting for physical rehabilitation across a wide range of conditions. By using the unique properties of water, therapists can help patients move more freely, lower discomfort, and build strength and confidence.  

For many individuals, especially those dealing with joint pain or mobility limitations, water-based therapy can make a significant difference in their recovery journey. As physical therapists continue to look for adaptable and patient-centered options, aquatic therapy remains a valuable tool in promoting movement and function. Its gentle environment and wide application make it a meaningful addition to physical therapy practice today.