The Benefits for Athletic Injuries
• Increased Mobility and strength
• Maintain fitness levels
• Decrease swelling
• Pain relief
• Removes weight from joints and bones
• Began jogging at an
earlier stage of rehab
• Buoyancy allowed Carson
Palmer to run neck deep
• underwater cameras
allow Bengals athletic
trainers to observe
movements and diagnose
any gait irregularities
History of Aquatic Therapy
• Hippocrates used hydrotherapy
extensively around 400 B.C.
• Was Commonly used in Europe.
– Treated diseases and maintained health.
• Aquatic based rehabilitation was not used
in the U.S. until early 1900’s.
• This form of rehabilitation has evolved
considerably throughout time.
Properties of Water
• Archimedes’ Principle
• Buoyancy- The upward thrust acting on in
the opposite direction of gravity
• Specific gravity- The ratio of the mass of
one substance to the mass of the same
value of water (Andrews,2004).
• Hydrostatic Pressure
– Pascal’s law
– Control effusion in an
– Increases blood flow
– Increase lymphatic
– Resistance to all fast
movements in water
• Physiological changes occur when a person is
immersed in water, both at rest and during
• Changes that occur during water immersion are
the result of hydrostatic pressure.
– Because of the increase in blood flow and volume, the
heart distends and myocardial wall tension increases
resulting in a Frank-Starling reflex and a increase in
stroke volume (Andrews,2004).
Physiological Effects Cont’d
• Water temperature for rehab is
recommended to be between 82 and 98
– Decrease joint stiffness
– Relieve muscle spasm
– Increase blood flow
– Assist in the inflammatory process
• Aquatic rehab offers advantages over land
– Buoyancy decreases weight bearing and joint
– The viscosity associated with water provides
accommodating resistance to exercise.
– Water provides a good environment for
• Key component to the rehab program
• Should have the appropriate warm up and cool
– Walking, jogging, bicycling motions
• Clinician can choose to rest the injured area or
challenge the muscles specific to the sport.
• Flotation vests may be used
• 25 minutes, 5 times a week is recommended
– Intensity and duration should mimic the athletes
• Restore osteokinematics and joint
• The buoyancy of water supports the extremities.
• Warm water can provide a relaxing environment
which may allow for increased soft tissue
• The duration of the stretch can vary.
• Stretching should be performed throughout the
Rehabilitation (Upper Extremity)
• The program should
be sport specific.
exercises that are
performed on land
can be performed in
• Overhead activities
Rehabilitation (Lower Extremity)
• Must consist of
• Open chain exercises
• Closed chain exercises
• Balance and
Rehabilitation (Core Strengthening)
• Core Body strength and postural control are
critical for any athlete (Andrews,2004).
• Most extremity exercises also train the core
– Standing leg kicks
– Shoulder flexion/extension
• Dynamic exercises
– leg lifts, straight leg lifting
• Eccentric exercises
– Can use a buoyant ball for exercises
Return to Sport
• An extensive aquatic rehab program will
challenge the athlete while allowing him/her to
train and condition along with providing
adequate recovery time (Andrews,2004).
• Clinician should rely on subjective input and the
athlete’s response to functional testing to
– Athletes should be able to complete any testing with
proper form and without any increase in pain or
swelling before resuming land activities
• Chronic pain
• Neuromuscular and
• Weight Loss
• Andrews R., James, M.D., Gary, Ed.D.,ATC
Harrelson L., and Kevin, PT Wilk E.
Physical Rehabilitation of the Injured
Athlete. 3rd ed. Philadelphia:
• Hydrotherapy. 20 Nov. 2006. 29 Nov. 2006
.html>. Path: Aquatic Rehabilitation.
• Hydroworx. 29 Nov. 2006. 24 Nov. 2006