Water Therapy Exercise Program

Water therapy exercise programs are done in a warm pool.  The buoyancy and warmth of the water leads to less pain, more comfort, and enough friction during the exercises to provide strengthening and enhanced mobility.

Water therapy exercise is especially helpful in cases where a land-based exercise program is not possible due to the gravitational load on the affected body part, intensity of pain, decreased bone density, disability or other factors.

Versions of water therapy are referred to in various terms, such as hydrotherapy, aquatic therapy, and pool therapy.

Conditions treated with Water Therapy Exercise

Physical therapy exercises done in a warm pool are a particularly good option for people with conditions such as:

• Arthritis – the buoyancy of the water reduces stress on arthritis joints, and water therapy generally improves joint movement and strengthens your muscles to better support your joints. See Osteoarthritis of the Spine
• Spinal stenosis – water therapy can gradually lead to return of motor abilities, and enhanced gait. It allows for physical activity without the stress of full body weight.
• Osteoporosis – advanced osteoporosis weakens your bone so much you’re susceptible to a bone fracture even with a minor amount of force. Exercising in water provides additional cushioning and support while building your bone strength.
• Muscle strain – A back muscle strain can be surprisingly painful, and water therapy provides pain relief by soothing the muscles within a supportive setting of warm water. With the weight of the body reduced while submerged, it’s easier to gradually build back strength while the muscle heals through controlled, repetitive movements.
• Lumbar herniated disc or lumbar degenerated disc - Water therapy allows movement and resistance without as much weight on the painful disc and spinal segment, making it a good exercise option to gradually regain mobility and strength.
• Long term pain. Many people with pain from bursitis, ankylosing spondylitis, fibromyalgia, tendonitis, hip labral tears, and other sources can benefit from exercising in the support of a water environment.
• Recovery from surgery. Water therapy is a good option to help some patients start physical therapy sooner (than physical therapy on land), leading to improved post-operative healing and reduced pain.

All these conditions can make it uncomfortable or painful to exercise on a hard or even padded surface, or while standing. Water provides a much gentler, welcoming environment.

In addition, water therapy is frequently recommended as one form of exercise therapy to treat those with diabetes as well as individuals with high blood pressure as well as many other chronic health conditions. Aquatic exercise can help improve these medical conditions and help make them more manageable.

Water therapy offers many of the same benefits associated with a land-based exercise program. Similar to land-based exercise programs, a specific treatment plan must be developed that is carefully tailored to the individual.

Benefits of Water Therapy

The physical properties of water make it a highly desirable medium for exercise if you have back pain and other musculoskeletal injuries.

Most people can move more easily in water. Water reduces the impact and pressure on your body. This may help you do physical therapy with less pain and effort.

The 5 primary reasons exercising in water is easier and highly effective are:

1. Buoyancy reduces pain

   Water counteracts gravity and helps support your weight in a controlled fashion as you’re immersed. This buoyancy reduces pain and strain as you go through your exercises.

2. Water improves range of exercises

   The buoyancy of water also permits a greater range of positions due to the virtual elimination of gravitational forces, particularly for exercises that require lifting the legs, the heaviest limb of the body for most people.

3. Viscosity increases strengthening

   Exercising in water provides a much greater amount of resistance by means of gentle friction, allowing more strengthening and conditioning of an injury.

4. Hydrostatic pressure improves healing

   The hydrostatic pressure when you’re immersed in water improves blood flow to your muscles, which in turn creates a better healing environment.

5. The support of water aids in balance and coordination

   The water aids in balance, helping hold you upright and in the appropriate exercise positions. It aids in coordination, providing support and gentle friction as you go through the exercises.

The water makes it easier to start exercise therapy

It is often easier to start an exercise program in the water before trying it on land. This means that you can potentially start rehabilitation sooner rather than waiting until you can tolerate land-based physical exercises.

See 10 Practical Tips to Start Water Therapy Exercises for Back Pain

For example, range of motion stretches for hip flexors and abductors are generally much easier to try out first in water because the buoyancy of the water supports the leg as you learn the right positioning for the exercise.

Buoyancy when doing water therapy exercises can be increased with the use of floats as well.

Together, these properties allow development of an exercise regimen that minimizes the weight placed on the spine (axial load) and risk of injury due to unintended movements during exercises.

For example, individuals with osteoarthritis in the neck and shoulder can practice arm circles or shoulder rolls in water to improve their range of motion and strength. Because the water provides both mild resistance and support through buoyancy, the person would most likely not experience the pain caused when a tired arm drops suddenly, as it can do at the end of land-based exercises.

Moreover, the perception of pain tends to diminish due to factors associated with water therapy, such as the relaxing sounds as well as the warmth of the water, making it a different and often very pleasurable experience.

Disadvantages of Aquatic Therapy Programs

There are few medical risks associated with water exercises, and it is considered safe compared to medical interventions such as injections, long term use of pain medications, or surgery.

However, because water therapy is done in a pool there are practical issues for anyone with back or joint pain, mobility and / or balance problems, or leg weakness:

• Accidents: Slips, falls, and other accidents can occur, such as when changing in the locker room and walking on a wet and slippery pool deck. It is best to plan to mitigate these risks, such as bringing someone to assist you, wearing water shoes with non-slip soles.
• Infections: Skin irritations and infections can occur from the locker room or pool. You can mitigate these risks by making sure you have no open wounds and choose a pool location that is well-maintained and clean.
• Muscle fatigue or increased pain: As with any exercise program, don’t do too much too fast. You can mitigate this by going to a class or working one-on-one with a trainer who will ensure a gradual and appropriate pace of exercise.

Effectiveness of Water Therapy for Painful Conditions

Water therapy is generally considered effective for low back pain and other musculoskeletal conditions.

One review of the medical research published in American Journal of Physical Medicine & Rehabilitation showed concluded that "Aquatic exercise can statistically significantly reduce pain and increase physical function in patients with low back pain."¹American Journal of Physical Medicine & Rehabilitation 97(2):p 116-122, February 2018. | DOI: 10.1097/PHM.0000000000000801

One study found that a 3-month aquatic therapy program for low back pain is effective in reducing pain, improving function, improving quality of life and sleep, and improving overall mental state. These outcomes were superior to the control group, which received passive therapy modalities of TENS units and infrared thermal therapy during the same time period.

The above results remained at the 12-month follow-up.²Peng, M.-S., Wang, R., Wang, Y.-Z., Chen, C.-C., Wang, J., Liu, X.-C., Song, G., Guo, J.-B., Chen, P.-J., & Wang, X.-Q. (2022). Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Network Open, 5(1), e2142069.

Importantly, one qualitative study revealed additional benefits of exercising in warm water.

This study used focus groups of people with arthritis pain, who stated that exercising in a warm pool provides both buoyancy and warmth which in turn makes them feel safe, do more exercises than they would otherwise do on land or in a regular (colder) pool, and provides meaningful physical and psychological benefits.³Larmer, P. (2014). "Patient reported benefits of hydrotherapy for arthritis." University of Brighton