Benefits & Research

Benefits and Research in Aquatic Physiotherapy

There is extensive research supporting the use of aquatic exercise in many types of conditions. In most of these clinical trials, particularly for hip and knee arthritis or joint replacement but also in back pain, shoulder pain and following joint sprains and after surgery, the water exercise programs are designed and supervised by a physiotherapist. These aquatic physiotherapy programs are based on a number of key benefits related to exercising in water.

Evidence based practice in aquatic physiotherapy relates to:

  • Reduced body weight load through the lower back and leg joints and muscles allows functional activities earlier in your rehabilitation program for your hip or knee such as walking and squats.
  • Load depends on the depth of immersion. Standing in water up to your waist is about 50% of your body weight and standing in water up to your chest is about 30% of your body weight
  • Load with walking also depends on how fast you are walking in the water.
  • Buoyancy and freedom of movement in water may help flexibility and pain. Pain may also be improved with less compressive load on joints.
  • Hydrostatic pressure is pressure from the water on your legs when you are standing in water. This gentle but strong compression from the water.
  • May help joint and leg swelling and circulation
  • Increases circulation of blood back to the heart which may have some additional benefits with cardiovascular fitness
  • Drag or turbulence created when you move in water can be a great source of resistance and strengthening.

Evidence based practice in aquatic physiotherapy relates to:

  • Integrating the conclusions of high quality research
  • Clinical experience of the therapist
  • Individual assessment and preferences of the person involved in a treatment or exercise program

The highest level of evidence is called a systematic review. A systematic review combines the results from many similar research studies called randomised controlled trials and summarises the information or findings from more than one research group. A randomised controlled trial is the next highest level of evidence.

The quality of randomised clinical trials relate to many factors including the numbers of participants in the trial, random allocation of the participants to the groups, blinding of the therapists doing the testing at the start and finish of the trial so they don’t know the type of treatment or exercise program that participants completed so there is less bias in the results, the similarity of the groups being compared and the statistics used. Choosing tests and measures that are relevant and reliable, how the clinical trial is described and also how many participants in the trial are also important.

Read more about systematic reviews or randomised clinical trials in the area you are interested in.

Becker B (2009) Aquatic therapy: scientific foundations and clinical rehabilitation applications.PMR.Sep;1(9):859-72
Hall J, Bisson D and O’Hare P (1990) The Physiology of Immersion. Physiotherapy, 1990; 76(9):517-521
Hall J, Swinkels A, Briddon J, Mc Abe CS. (2008) Does Aquatic Exercise Relieve Pain in Adults With Neurologic or
Musculoskeletal Disease? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Archives of
Physical Medicine and Rehabilitation, 89 (5):873-883
Harrison R and Bulstrode S (1987): Percentage weight-bearing during partial immersion. Physiotherapy Prac 3:60-3
Harrison R, Hillman M, Bulstrode S (1992): Loading of the lower limb when walking partially immersed: Implications for clinical practice. Physiotherapy 78: 164-6

Aquatic Physiotherapy