A recent review of aquatic therapy for Osteoarthritis (OA) of the hip or knee concluded that pain may be decreased by aquatic therapy. Because of the water temperature and the decreased loading, aquatic exercise is often considered an ideal place to begin exercise or for those in the more advanced stages of the disease where exercise on land has become too difficult.

Clinicians often contend that aquatic physiotherapy offers greater pain relief than land-based intervention in musculoskeletal conditions. One study comparing similar land- and water-based exercises for people with knee OA showed no significant differences between the interventions in range or walking distance but postexercise pain was less in the water-exercise group.

Similarly, when comparing aquatic training group and land-based progressive resistance training group, the aquatic training group reported significantly less postexercise pain. People with late-stage OA awaiting joint replacement surgery experienced less pain immediately after an aquatic exercise program than those who undertook land-based exercise. Orthopedic inpatients completing an intensive aquatic exercise program also reported significantly less pain during intensive aquatic exercise and perceived less difficulty than when undertaking usual ward exercise. However, aquatic exercise for people in pain must be undertaken with caution clinically because reduced pain perception during aquatic exercise may make it easier to over-exercise because the perceived workload is less than during land-based exercise. Although systematic reviews were unable to confirm the clinical contention that aquatic exercise can reduce pain, the methodological processes required in meta-analysis may dilute the results of the few, small positive trials. Further research is clearly warranted to determine whether this clinical perception is supported.

Aquatic exercise may have an effect on pain because of buoyancy and the hydrodynamics related to moving in water. The effect of buoyancy could reduce pain during exercise because the depth of immersion is directly related to the percentage weight bearing. Weight bearing when immersed to the neck is considered to be 30% at the chest, and 50% at the waist. To reduce load and pain in the joints, the individual can exercise in deeper water or conversely to progress weight bearing and load, exercises can be undertaken in shallower water. The ability to easily alter weight bearing to reduce pain during functional exercises is not possible in land-based exercise programs. A small clinical trial recently demonstrated that aquatic immersion restored normal spinal stature more effectively than an equivalent land-based position, adding support for the argument that immersion decreases joint loading. Immersion in thermoneutral temperature water is commonly thought to reduce pain because sympathetic nervous system conduction slows, thus reducing pain perception. The compressive effects of hydrostatic pressure in combination with the circulatory changes that occur with immersion reduce swelling, allowing greater movement to reduce joint and soft-tissue stiffness and, therefore, improve pain levels. To date, one small randomized control trial did show a difference between a general water exercise program and a specific aquatic exercise program designed with an understanding of hydrodynamics and movement in water. Whether the positive effect of aquatic exercise on pain found clinically is due simply to the hydrodynamics of immersion or is related instead to the aquatic exercise intervention requires further research.

Just as in a land-based physiotherapy practice, in aquatic physiotherapy practices where the physiotherapists are in the water and able to treat people individually, it is common clinical practice to include specific manual therapy techniques with the aquatic exercise program.

If you have sustained a hip or knee injury, suffer from osteoarthritis or a slew of other musculoskeletal conditions, please see a specialist at the PRI clinic. This multi-disciplinary team is specifically trained to properly introduce their body to aquatic therapy, which will allow a remarkable improvement in their lifestyle. To book a consultation, please call or follow these links.

 

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