What exactly is Aquatherapy? How does it work? Who is it suitable for? Medindia got the answers from Dr. Jan Prins who is a professor at the University of Hawaii and the director of the Aquatics Research Laboratory. He has now established an aquatic physical therapy clinic in Colombo, Sri Lanka, bringing the program to the country of his birth.

1. Can you tell us what medical conditions can be effectively treated by Aquatherapy? Is there any one condition it is particularly useful for?

Aquatherapy is effective in the treatment of a large variety of conditions. I do not think there is any single condition that it is more effective than any other. Clearly, conditions that are exacerbated by gravity, i.e. weight-bearing, respond well in the water.

1. Orthopedic conditions associated with the major joints: Neck, back, shoulder, hip, and knee injuries
2. Recovery from work injuries and auto accidents
3. Hip & knee replacement
4. Recovery from CVA’s (stroke) and neurological injuries which includes “balance training” for fall prevention.
5. Rheumatological conditions - Arthritis, Fibromyalgia
6. Diabetes – exercising with a reduction in joint trauma.
7. Athletic injuries.
8. Osteoporosis.
9. Conditions exacerbated by changes in body alignment during pregnancy.
10. Injuries that are either recent, or old, but still cause pain and discomfort.

2. What Makes Aquatic Therapy Work?

Two important physical properties of water, buoyancy and viscosity, are key elements in designing effective aquatic exercises.

The advantage derived from buoyancy is direct; when a person enters the water there is an immediate reduction in the effects of gravity on the body. The buoyant force of water decreases the effective weight of an individual in proportion to the degree of immersion. The ability to control joint compression forces by varying degrees of immersion is of primary benefit in the design and prescription of conditioning and therapeutic exercises. By monitoring the depths at which functional movements such as walking and stepping are performed, the effect of gravity can be re-introduced and, consequently, gradual strengthening is promoted.


The viscosity of the water has an indirect advantage; when moving through the water, resistance is felt. The degree of effort is determined by the size of the moving body or limb, coupled with the velocity of the movement. Although traditional modes of strength training are used successfully on land, there are primary advantages for using water resistance to promote strengthening. Water acts as a variable accommodating resistance. The advantage of an accommodating resistance is that it matches the applied force or effort. Because the resistance of the water equals the force exerted, the probability of exceeding tissue tolerances is reduced and the likelihood of exacerbation when building strength after injury or re-injury is dramatically reduced.

3. What are the kinds of results we can expect from Aquatherapy? Can you tell us if aqua-therapy can help people with backache and for treating other conditions associated with the spine?

Axial loading on the spine and weight-bearing joints, particularly the hip, knee, and ankle, is reduced with increasing depths of immersion. When standing in chest-deep water the weight-bearing load is approximately 40% of the total body weight. When stepping up onto a submerged step in the water, the body rises to waist-depth, increasing the gravitational load to approximately 60% of body weight. When floating in the prone, supine, or vertical positions, the effects of gravity are, for all practical purposes, eliminated.

Because axial and compressive forces are reduced in the water, a case can be made for early prescription of aquatic therapy. When it is premature to resume full weight-bearing activities but important to beginning closed kinetic chain exercises, exercising in the water at graduated depths is ideal. These patients can later transition to land-based physical therapy to continue their prescribed rehabilitation program.

4. Can you tell us some real incidents where you noted a remarkable improvement in the patient’s physical state after aquatherapy?

Over the past 20 years, we have treated almost 4,000 patients.

Here’s one of the most dramatic. I have also included some of the comments we have had which we use as testimonials.

• Fourteen year-old girl was referred to our clinic in Hawaii. She was diagnosed with Aseptic bone necrosis – resulting in a non-union fracture of neck of femur (the long thigh bone).

• She was not mobile and arrived in a wheel chair.

• Because of her intolerance to even modest gravitational loads she performed all her exercises while submerged in the water, up to shoulder depth.

• As her tolerances increased she graduated to shallower depths, and eventually was able to leave the clinic six months later with only the use of a walker.

Testimonials

“I wish my doctor had sent me here first.”
-A.B. (Chronic low back pain, knee pain)

“I have spent the last ten years trying every form of therapy I could find, unsuccessfully. Prins Aquatherapy is the first that has helped. Overall, long-term, it’s working. And it’s the first thing that has.” -R.C. (Series of accidents)

“The exercise movements I participate in feel natural, and being submersed in water is relaxing. The exercise is virtually pain-free and I do not feel inhibited with the idea that I might hurt myself with any of the prescribed motions.” -A.L. (Back injury, automobile accident)

“I’m able to do more movements than I could in regular land therapy because of the support the water gives. Just being able to walk in the water without my crutches is a great relief. It has helped me strengthen and retrain my muscles in my injured leg.” -A.R. (multiple fractures of leg)

“I have been looking for a way to get back in shape without hurting myself. I had the preconception that you couldn’t exercise hard with Aquatherapy, however, with the program my Physiotherapist developed for me, when I get out of the water I know I’ve had a real workout.” -L.W. (pelvic injury)

5. How can Aquatherapy help people with autism or children with ADHD, or people with mental illness? (Since you mention in your website that you get references from psychiatrists)

We don’t know the exact causal mechanisms but it appears that the sustained, rhythmic movements have a reassuring effect on children diagnosed with Autism and ADHD. Parents report their children being a “lot calmer” for a number of hours following aquatic sessions.