Aquatic Therapy Clinical Rehabilitation Concept in Rheumatic diseases

Aquatic Therapy Clinical Rehabilitation Concept in Rheumatic diseases

Dr. Fahmy Imam Fahmy MD

Professor of rheumatology and rehabilitation Azhar University

A quatic therapy is the physical therapy that takes place in a pool or other aquatic environment under the supervision of a trained healthcare professional. Aquatic therapy is also known as water therapy, aquatic rehabilitation, aqua therapy, pool therapy or hydrotherapy. Current rehabilitation professionals generally define hydrotherapy as a pool therapy program specifically designed for an individual in an attempt to improve neuromuscular and skeletal function. The use of hydrotherapy as rehabilitation tool was first described by Hippocrates (450 - 375 BC) and is now commonly employed by physiotherapists and occupational therapists. The use of water for restorative purposes has grown in popularity and has gained increased use in facilitating therapeutic exercise(1). The unique physical properties of the aquatic environment provide clinicians with treatment options that may otherwise be difficult or impossible to implement on land.(2)

These are some of the ways that natural properties of water creates an ideal therapeutic environment:

• Warm water provides a relaxing and soothing environment for aching joints and muscles.(26 C and 33 C).

• Water’s natural viscosity or resistance can be used for musclen strengthening and increasing rehabilitation progressions.

• Buoyancy allows for flotation and reduces the effects of gravity on injured or aching joints and muscles.(3-4).

• Hydrostatic pressure supports and stabilizes the client, allowing people with balance deficits to perform exercises without a fear of falling, decreasing pain and improving cardiovascular return.

• Turbulence and wave propagation let the therapist gently manipulate the client through the desired exercises

Safety of aquatic exercise programs

Even though aqua therapy typically takes place in a fairly shallow pool, it is not risk free. To provide a safe environment for clients, The suitability for aquatic therapy for a client should be decided on a case-by-case basis. Here are some situations where aqua therapy may not be an appropriate course of treatment: Open wounds, skin diseases,fever,urinary tract infections,chemical allergies,cardiac problems ,seizures , fear of water and severe hypertension/hypotension

Rehabilitation Applications In Arthritis and Related Disorders

The value of the aquatic environment has a longer

history in the management of arthritic diseases

than in almost any other disease group. The

losses that accompany chronic joint disease are

many: loss of strength, loss of joint mobility and stability,

and altimately loss of functional capacity. It has been

noted that rheumatoid patients as a group have lower than

expected aerobic capacity and physical performance, with

overall muscle strength 60% below that of age-matched

control subjects. These deficits respond promptly to

active rehabilitation, with well tailored strengthening

and endurance programs achieving gains in physical

performance levels in as brief a time as 6 weeks(5)

Long-term exercise regimens in rheumatoid patients

over many years have been well tolerated, with resultant

improvement in functional and other outcome measures (6).

A recent study of the cost-benefit in persons with

osteoarthritis demonstrated that individuals enrolled in an

Arthritis Foundation aquatics course significantly reduced

perceived disability related to arthritis and improved

perceived quality of life specific to physical health (7).

Because patients with arthritis have been shown to

have decreased endurance, these individuals should

participate in some form of aerobic exercise to enhance

their overall fitness. Studies have demonstrated the

benefits of aerobic exercise for many conditions, including

fibromyalgia pain (8-9-10).

Low-impact exercise has been shown to be more efficacious

than medications in the self-management of osteoarthritis (11).

Because the safest medium to reduce impact in the pool,

the incorporation of aquatic exercise and/or swimming

provides an advantageous alternative to manage arthritic

symptoms. This argument has been substantiated in two

studies of patient groups, with nonacute rheumatoid and

osteoarthritis participating in water exercise regimens. In

a study of rheumatoid patients, Danneskiold-Samsoe et

al. found markedly increased isometric and isokinetic muscle

strength of the quadriceps after only moderate training

in the pool. Other gains included an increase in aerobic

capacity, freedom of movement, and a higher degree of

independence in activities of daily living (12).

Postural sway, a factor associated with fall risk, has been

shown to decrease in patients undergoing a 6-week

aquatic exercise intervention (13).

Bunning et al. concluded that pool therapy was efficacious

and achieved high compliance for those with osteoarthritis

and that aquatic exercise should be the cornerstone of

active rehabilitation for severe arthritis. Patients who

participated in the study exhibited significant improvements

in aerobic capacity and physical activity level and were

less depressed than controls (14).

Offloading of body weight occurs as a function of immersion,

but the water depth chosen may be adjusted for the amount

of loading desired

Rehabilitative programs for specific joints may be more

effective as either closed or open kinetic chain programs.

Shallow-water vertical exercises generally approximate

closed chain exercise,albeit with reduced joint loading

because of the counterforce produced by buoyancy (15).

The hydrostatic effects of immersion, possibly combined

with temperature effects, have been shown to significantly

improve dependent edema and subjective pain symptoms in

patients with venous varicosities (16).

Hydrotherapy and rehabilitation of patients with anterior

cruciate ligament disruption. Thomson et al conducted

a Cochrane systematic review on the effectiveness of

physiotherapist-led programs and interventions for

rehabilitation of anterior cruciate ligament (ACL), medial

collateral ligament (MCL) and meniscal injuries of the knee

in adults. The authors conducted searches on Cochrane

Musculoskeletal Injuries Group specialized database (17).

Another important advantage of aquatic therapy is that it can

often begin before land-based therapy. For athletes looking

to get back into competition, or busy professionals who want

to recover from surgery as quickly as possible, this makes a

water-based program the natural choice .(18)

Numerous studies of fibromyalgic patients have

demonstrated reduction in pain, improvement in sleep

patterns, fibromyalgia impact, mood state disorders, and

when compared with land-based exercise programs, the

aquatic groups typically showed faster and larger gains, with

longer post-study improvements (20-21).

Compare aquatic therapy to other forms of physical therapy,

aquatic therapy results in a higher client compliance rate and

less pain throughout the recovery process. Opportunities to

significantly minimize the pain a client experiences should

be taken seriously because with less pain, a client can enjoy

a higher quality of life.