The benefits of Aqua Therapy rehabilitation

on November 2, 2020

Aqua therapy has become a popular rehabilitation technique amongst physio- and sports-therapists. In aqua therapy,  water becomes a therapeutic exercise medium. A pool is the safest environment to perform any exercise, due to the low impact of physiological loads in the water, in comparison to on land. In this article, we will explore the benefits, challenges and techniques of aqua therapy.

Before starting, let’s differentiate between the different water-based therapies:

  • Aqua therapy uses mechanical and thermal characteristics of water during partial or complete immersion, in combination with the effects of movements.
  • Hydrotherapy simply means the complete immersion inside the water.
  • Water therapy is where water is used as a direct medium, for example as an ice bath, contrast bath or whirpool.
exercise in aqua therapy

Aqua therapy can be beneficial and useful in the treatment of everything from orthopaedic injuries to spinal cord damage, chronic pain, cerebral palsy, multiple sclerosis, stroke, and many other conditions. Aqua therapy is also widely accepted as preventative maintenance tool to facilitate overall fitness, cross-training, and sports-specific skills for healthy athletes. Other than that, it can also be implemented in general conditioning, strength and a variety of movement skills training.

In addition, the temperature of the water inside the pool can be varied according to the patients condition. For athletes the temperature ranges from 26°C to 28°C, while for patients with arthritis or neurological conditions the water temperature must be maintained between 29°C to 31°C. This is to ensure the aqua therapy treatments are delivered appropriately.

buoyancy in aqua therapy

An athletic trainer or physiotherapist must understand several physical properties of the water before designing an aqua therapy program. Buoyancy is one of the primary forces involved in aqua therapy. Either land or water all object subjected to downward pull of the earth’s gravity. However, in the water this force is counteracted (to a certain degree) with upward buoyant force. The buoyant force assists motion towards the water’s surface and resists motion away from the surface.

Thus, a person entering the water experiences an apparent loss of weight. Due to the decrease in body weight produced by the buoyant force, every joint inside the water is decompressed and unweighted. Therefore, it allows greater locomotion and vigorous exercise to be performed with little impact to the joints.  The buoyant force also helps remarkably reduce the friction between articular cartilage within the joints. Hence aqua therapy is highly recommended for arthritis patients. The diminished pressure on the joints helps in relieving pain and reducing oedema.

Applications and benefits of Aqua Therapy

There are many applications of aqua therapy.  In the early rehabilitation phase, aqua therapy benefits athletes and patients in restoring range of motion and flexibility. Following which resistance training and sports-specific training can be added as the normal function is restored. The slow-motion effect in water allows the patient to more easily experience multi-angle movement errors without any severe consequence (due to the reduced joint pressure). It also assists patients in regaining balance and proprioception as the fear of falling or re-injure is significantly reduced.

The turbulence function in aqua therapy gives the perturbation challenge that helps further restore coordination and balance. In addition, hydrostatic pressure helps in oedema reduction which together benefit pain reduction and increase range of motion.

The buoyancy principle in aqua therapy can provide gradual improvement from non-weightbearing to full weightbearing land exercises. These gradual transition helps reduce pain and ensure smooth coordinated movements. Buoyancy force reduces the apparent weight and joint compressive forces, meaning locomotor activities (gait training) can begin earlier following a lower limb injury.  Aqua therapy is psychologically boosting the athlete to work out without fear of re-injuring and helps patients’ bodies return to their normal function.

Furthermore, muscle strengthening and re-education can be achieved with aqua therapy. The intensity can be controlled by manipulating the flow of the water turbulence, allowing  minimal muscle contraction and transition to resistive workout when the athlete is nearing full recovery. Aqua therapy requires more energy expenditure in comparison to land exercises as the patient needs to overcome the resistive force of the water.

Finally, for neurological conditions, aqua therapy also provides relaxing effects and the warmth of the water helps reduce the muscle tone and spasticity. In addition, it also helps with regaining the trunk balance and promotes lumbar stabilization.

Aqua therapy helps in cardiorespiratory fitness through alteration in cardiovascular dynamics due to hydrostatic force. In addition, the heart functions more efficiently in water. As an added bonus, aqua therapy also helps reduce stress and promotes overall relaxation.

Injuries that benefit from Aqua Therapy

Aqua therapy can be beneficial for most of the orthopaedic and neurological condition/ injuries. Such as:

Upper LimbLower LimbTrunkNeurological Condition
OsteoarthritisOsteoarthritisLower Back PainBalance disorder
Rheumatoid arthritisRheumatoid arthritisSpinal Cord DamageTraumatic Brain Injury
BursitisBursitisSpinal degenerationMultiple sclerosis
Chronic painChronic pain Stroke
Rotator cuff tendinopathyACL reconstruction Cerebral Palsy
Shoulder impingementPCL reconstruction  
SprainsAchilles tendon rupture  



Challenges of Aqua Therapy

The primary disadvantage of aqua therapy is the cost of building and maintaining the rehabilitation pool. Besides that, qualified pool attendants must be present and the therapist must be trained in aquatic safety and therapy procedure. The therapist must pay careful attention to any patients who have difficulty in stabilizing.

Moreover, the water temperature plays an important role throughout the rehabilitation session. A water temperature greater than body temperature will increase the core body temperature greater than land-based exercises would. On the other hand, water temperature lower than body temperature will decrease the core temperature and may cause shivering or even cramping.

Finally, aqua therapy also contains and inherent of risk of drowning for those who are not used to aqua exercises. Thus, aqua exercise should always be performed under supervision or in shallow water if alone.

Contraindications and precautions

There are many contraindications and precautions that must be taken into consideration by the therapist before beginning the aqua therapy session with their patients or athletes. The most common contra indication is an open wound, unhealed surgical scars or contagious skin disease. This must be restricted to prevent the chance of infection to the patient or others who utilise the pool. Those experiencing fever, urinary tract infection (UTI), menstruation, allergies towards pool chemicals, heart problem and uncontrolled seizure (will increase risk of drowning) are also recommended against the use of aqua therapy. Safety precaution must be taken if the patient has uncontrolled high or low blood pressure and also patients with uncontrolled bowel or bladder incontinence.

In addition, there are some injuries that are not suited to aqua therapy. For example, as much as the multiangle motion helps in balance and proprioception, it also can be contraindicated to PCL Reconstruction as the water resistance will cause posterier tribal translation. PCL Reconstruction may require longer period to ligamentize, hence aqua therapy may not be advisable for the early phase of rehabilitation.

Finally, there are a number of safety measures that must be in place during aqua therapy. Oftentimes patients will be referred for aqua therapy who are uncomfortable or unfamiliar with deep water. The therapist must understand that swimming ability is not mainstream, but of course highly recommended to participate in aqua therapy. Clear instruction of water safety skills helps in conducting satisfying and safe rehabilitation sessions. In the initial stage, an exercise bar or floating noodle may be needed to assist with ambulation in water. This will also help decrease fear and stress for the patient and reduce stress to injured area.

Facilities and equipment used in Aqua Therapy

Some aqua therapy pools come pre-fabricated with an in-water treadmill, exercise bike, or a current-producing device. A current-producing device is integrated in more advanced pools which then also incorporates moveable floors, resistance jets to generate and control added resistance while training in the water, therapeutic massage jets to massage under water and computer monitoring & recording systems to assess patient movement during aqua therapy. These devices can be beneficial but are not essential for all treatment purposes.

equipment in aqua therapy

Other equipment used in aqua therapy are a therapeutic water running belt, therapeutic kickboard, floaty dumbbell, and sausage floats. Sports specific equipment can also be used if it safe to go into the water (such as a racquet). Creative usage of one of the floating tools or actual sports equipment (baseball bats, tennis racquets, golf clubs) is helpful to incorporate sports-specific activities that challenge the athletes with familiar movements.

Equipment or pool toys are limited in usage; thus, the therapist must be creative in designing their rehabilitation program to achieve the targeted goals. Besides that, the aqua therapy program also must stimulate the patient’s interest and motivation for therapy to help achieve their goals in line with the therapist’s program. Besides this, use of proper clothing is also important. Wearing swimwear shows aquatic professionalism, while proper aquatic foot ware provides stability and traction, prevent injuries, and maintains good foot positions.

Aqua Therapy vs Swimming

How does aqua therapy differ from swimming? Swimming consist of four major strokes: free style, back stroke, breaststroke, and butterfly. In general swimming helps in improve flexibility, strength and cardiovascular fitness. Aqua therapy also has similar effects, however primarily involves physical movement focused on the injured area.

In conclusion, aqua therapy offers many positive psychological and physiological effects during the early rehabilitation of acute injuries and also chronic pain. However, normally in later phases of rehabilitation both water and land exercises must be conducted to achieve the desired goals. Occasionally, aqua therapy will be continued for strength and conditioning training for patients with painful response to land-based activities. For example patients with disc dysfunction, spinal stenosis, and osteoarthritis would all benefit from aqua therapy training.

Aqua therapy  has many beneficial effects, such as relieving pressure from the joints by eliminating or drastically reducing the muscle spasm and joint pain. This helps patients to return to their normal daily activities without fear of pain or potential re-injury.

Fundamentally, the swimming pool is therefore not only used for swimming: It can also be used as a medium for treatment and rehabilitation.

Do not make the mistake of taking Google’s word as scripture, consult a therapist now. If you want to know more about Aqua Therapy, feel free to give us a call at 03-50315946 or send us a Whatsapp or Make an Appointment. We at Rehamed Therapy are always here to help!


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