What is aquatic physiotherapy?

Aquatic physiotherapy uses the skills and knowledge of the physiotherapist related to rehabilitation, health, muscles, bones, walking, posture and exercise. It also involves individual assessment and goal setting. Aquatic Physiotherapists have  extra training and knowledge in exercising in water related to the physiology of being immersed and the physics of forces and load in water. Exercise in the water utilises the properties of buoyancy and the subsequent unloading of joints, drag and turbulence for strengthening and a supportive environment for cardiovascular fitness training. Aquatic physiotherapy is active and involves exercise.

What is the difference between hydrotherapy and aquatic physiotherapy?

Hydrotherapy is the older terminology for aquatic physiotherapy in Australia. The term aquatic physiotherapy has been used in Australia for nearly 20 years (Australian Physiotherapy Association, 2002) and more recently this change has also been made by physiotherapists in the UK. In the USA it is called aquatic physical therapy. Aquatic physiotherapy is usually done in a hydrotherapy pool but can also be done in a swimming pool. Hydrotherapy Pools are defined as a pool that is purpose built for therapy and maintained at a warmer temperature than a swimming pool, usually around 34 degrees (Australian Standards AS3979-2006 Hydrotherapy Pools). In Europe, physiotherapists still use the term hydrotherapy. Hydrotherapy can encompass any therapy that uses water in any way (hot, cold, steam or ice). Hydrotherapy has been used by many ancient civilizations (for further information, see Wikipedia  http://en.wikipedia.org/wiki/Hydrotherapy ). Balneology or balneotherapy is another term commonly used in Europe for bathing in (or drinking) mineral spa water for health. Balneotherapy doesn’t usually involve exercise so in this way it is very different from hydrotherapy supervised by a physiotherapist or aquatic physiotherapy.

 Does aquatic physiotherapy work?

Yes. High quality clinical trials in both hip and knee osteoarthritis and joint replacement have shown aquatic physiotherapy to be beneficial for pain, quality of life, walking and stair climbing. There are also studies showing benefits in many other conditions including back pain, rheumatoid arthritis, shoulder rehabilitation, joint sprains, anterior cruciate ligament reconstruction and fibromyalgia.

For further information please read more on research and evidence in aquatic physiotherapy you can see this report from Musculoskeletal Australia on water exercise or have a look at this brief summary of benefits https://www.aquaticphysioexercise.com.au/benefits-research/

What is the difference between a physiotherapist and an aquatic physiotherapist?

All physiotherapists in Australia have University qualifications that allow them to be registered through the Australian Health Practitioner Regulation Agency with the Physiotherapy Board of Australia.  Physiotherapists base their programs on clinical research and evidence.  Aquatic physiotherapists have further training on exercise in water and can target your pool-based exercises to get specific results for flexibility, strength, walking, balance, pain managment or a mix of the most significant limitations.  Like all professional physiotherapists, standard methods of assessment and interview are used to create an individualised program to address the main problems.  Aquatic physiotherapists use their expertise with movement, joints, muscles, inflammation, load and exercise to progress this exercise program and provide other advice about posture, pain management and health. You can read more about aquatic physiotherapy here.

Do I need to be able to swim do aquatic physiotherapy?

Quite a few people in these groups cannot swim and are nervous of exercising in water but still enjoy aquatic physiotherapy.  The pools usually have a shallow end where most exercises are done standing up.  During the first few sessions the Aquatic Physiotherapist will always be close by.  All the exercises are initially easier and then progressed to be more difficult as your confidence in water grows. All exercises can be modified for someone that cannot swim.  With time, most people become much more confident in water and enjoy the sessions and this opens up a whole new option for exercise for rehabilitation and exercise for fitness.

Do I need a referral from my Doctor for Aquatic Physiotherapy?

No, you do not need a referral from your Doctor.  If there are any concerns related to your medical history then we will contact you Doctor, with your permission, for further information.  Of course it is always a good idea to discuss your thoughts on treatment options with your Doctor and we will update them on your progress if you would like information to be sent to them.

Do I need a referral from my Physiotherapist?

Yes (for the general Aquatic Physiotherapy groups) to provide information on your diagnosis, physical function and health to help provide the most targetted aquatic program for your condition.  If you don’t have a Physiotherapist then give us a call to discuss further, we can help recommend someone for you.

You don’t need a referral from a Physiotherapist for the Hip and Knee group.

How soon after my hip or knee joint replacement can I start exercising in water?

You need to discuss this with your surgeon.  The timing mainly relates to wound healing and your surgeon will have a protocol about whether the wound needs to be totally closed over and healed before you start in the pool which may take 2-3 weeks or they may allow you to start earlier than this with the wound covered by a waterproof dressing.  Speak to your surgeon further about this.

When is the best time for me to do an aquatic physiotherapy program for my hip or knee joint replacement?

The research shows us that early after the surgery aquatic physiotherapy allows comfortable normal movement particularly with walking and helps improve your muscle strength.   3 months after the surgery is another window of opportunity to push a bit harder with exercise and water based rehabilitation.  Usually up to 12 months of rehabilitation and ongoing exercise is recommended but ongoing commitment to exercise and physical activity is important.

For further information have a look at the BENEFITS AND RESEARCH page and the Clinical research summary for hip and knee joint replacment   https://www.aquaticphysioexercise.com.au/benefits-research/

I am scheduled to have a hip or knee joint replacement in a few months, is there any value in me doing aquatic physiotherapy before the operation?

It depends on your individual situation.  In most circumstances, exercise to become a little stronger before the operation will be of benefit after the operation.  Aquatic exercise is a comfortable way to exercise prior to your surgery except in situations where you are in extreme discomfort.  For further information on the research in this area have a look at BENEFITS AND RESEARCH page and look at the clinical research summaries on Pre-operative aquatic exercise prior to joint replacement  https://www.aquaticphysioexercise.com.au/benefits-research/

Can exercise cause damage to my joint if I already have arthritis?

Physiotherapy or rehabilitation exercise programs have controlled load. Provided trauma is avoided (uncontrolled twisting or anything extreme), moderate exercise does not lead to acceleration of knee osteoarthritis.

Exercise really helps people with arthritis get stronger, get moving and have less pain. You can read more about the benefits of exercise and physical activity from Arthritis Australia here.

Aquatic physiotherapy has the added benefit of less vertical weight bearing load on the joint but can still push you hard with strengthening and also cardiovascular conditioning for your general health. Contact us to find out more.

I would like to try aquatic physiotherapy for my hip or knee but I also have lower back pain, is the hip and knee group suitable for me?

It is common to have lower back pain and also hip or knee pain.  The hip and knee group classes and programs focus mainly on leg flexibility, balance and strengthening.  A small number of back exercises can be added in to your water exercise program by your aquatic physiotherapist but it will not be the focus of your sessions.  If in doubt, please call us to discuss further.

What other options are available for water exercise groups for people with arthritis?

Outside aquatic physiotherapy sessions, general water exercise can be accessed via aqua fitness or aqua aerobic classes at your local pool or local arthritis group may also run programs. Always consult your doctor or your local physiotherapist about the most suitable exercise for you.

For further information on Arthritis Australia or Musculoskeletal Australia and other options go to these useful LINKS for all health conditions


What is the difference between an aqua aerobics or aqua fitness class and an aquatic physiotherapy session?

Most water fitness or aqua aerobics sessions are done in a class format in deeper water.  Most participants are completing the same or similar fitness exercises for the whole session with general fitness or flexibility aims.  The instructor can modify exercises you are having difficulty with.  Group size with aqua aerobics can be 20 participants or more.  These are fitness programs rather than rehabilitation oriented programs.  So aqua aerobics is a good option if you want to improve your fitness but speak to your doctor about whether this type of exercise is appropriate for you.

An aquatic physiotherapy session is based on an individual assessment before you start and is tailored specifically to your needs.  A large proportion of aquatic physiotherapy exercise is done in the shallow part of the pool making the most of partially weight bearing strengthening exercises.  The group size in aquatic physiotherapy sessions will usually be 6-8.  Physiotherapists have extensive training around joints, muscles, coordination, motor control, posture, function and pathology as well as exercise.  Physiotherapists base their programs on clinical research and evidence.  Aquatic Physiotherapists have further training on exercise in water and in conjunction with an individual assessment can target your pool-based exercises to get specific results.  You can build on your progress with each session in a logical way to maximise your improvements.