GLOBAL HEALTH AGING

In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on aquatic therapy. This is Part 4 in this series. Part 1 focused on the aquatic therapy marketplace, Part 2 focused on selecting an aquatic practitioner and Part 3 focused on selecting an aquatic facility. Thank you for reading!

Aquatics Programming may be found in a class format or individual, one-on-one, personal training. Variances occur when the instructor is in the water or on the pool deck; the instructor can be demonstrating moves or simply observing.  In one-on-one training, a physical therapist may demonstrate on the pool deck and then oversee land-based exercises to be performed in water. This article will present an overview of just aquatic therapy programming–oftentimes misconstrued by physicians and other healthcare providers as water aerobics, as they have not learned to differentiate between aquatic exercises and therapies.

Within aquatic therapies, class formats are usually considered “active” therapies, meaning the therapist is demonstrating moves to be performed by the participants using visualization or verbal cueing to effect the desired movement(s). “Passive” therapies require the therapist to be in the water with the participant, physically manipulating the participant in a one-on-one mode of care.

Active therapies are by far the more commonly observed practices in either class or personal format. In active therapies, the practitioner can be demonstrating the moves whether on the pool deck or in the water. Many participants prefer a practitioner on deck where moves can be easily seen and more closely modeled by the participant.  However, there are unknown advantages to having the practitioner in the water with the participant(s). The practitioner can more concisely cue the participant to specific considerations that may be experienced in water, not commonly observed or experienced when the move is performed out of the water. For instance, a leg lift to the side, when performed on deck, is more easily aligned when the buoyancy and resistance of the water is not altering the form of a truly lateral abduction. When a practitioner instructs from the water, he or she may lift the leg sideways but it may be forward of the midline of the hip joint. By cueing the participant to turn the toes inward, the outside of the ankle leads the abduction, effecting a more true lateral abduction. The slight turn inward of the toes strengthens the leg muscles needed to perform the movement, which then translates to a more stable leg lift on land. This is because the muscles have been trained more strongly against the added resistance of the water.

Physical therapists who do not have aquatic training may never come to understand this variance in experience between land and water. Therefore, they can not ever use the water to its fullest multi-planar or “omni-directional” benefit. To be fair, even people trained in aquatic therapy may not become fully aware of this omni-directional efficacy unless they have spent a lot of time in the water, performing the movements they instruct the participants to carry out.

In class formats, there are many kinds of therapies that can be conducted: Yoga, Aqua Stretch, Aqua Pilates, Ai Chi and Watsu are some examples. While Watsu is a “passive” therapy, meaning the practitioner is usually the one to move the extremities of the participant, a therapist can lead a class of paired participants and cue and observe each pair in their therapy. Likewise, Ai-Chi-Ne is a paired participant therapy class. For the purpose of example, a brief explanation for Ai Chi will be included in this article.

Ai Chi, a Japanese aquatic therapy, is oftentimes confused with the land-based Chinese Martial Art, Tai Chi. In a lot of ways, the practices are similar and the newer Ai Chi is based upon the martial art. However, when done in water, Ai Chi accomplishes different objectives of wellness and mind/body self-care. It has a very restorative, if not healing effect when practiced regularly. Moreover, Ai Chi coordinates controlled fluid movements with deep, diaphragmatic breathing in through the nose, but out through the mouth. Its relaxation effects are bridging the mind’s control of the body through the control of breath. It is said that, “the breath is the bridge between the mind and the body.” When practiced regularly, the healing effects of the therapy can be profound. Ai Chi is a cultivation of the energies in and around the body, drawing in healing energy and expelling toxic or harmful stressors.

In a one-on-one aquatic therapy session, a powerful bond is created between the practitioner and participant when both are in the water. Inexplicably, the shared common experience endears the participant to the practitioner, establishing a stronger trust and respect than when a practitioner stays dressed in street clothes, sits on a chair on the pool deck and perhaps keys entries on their computer, while the participant completes the instructed movement(s) or repetitions of a move.

In sports therapy pools, the trainer is like the therapist on the pool deck, but expensive underwater video and monitor equipment enables the trainer to observe the form and kinesiology of the participant. This insures proper  form and alignment therefore maximum potential for improvement. The trainer is also acutely focused on the athlete whose sole objective is to increase maximal performance. Non-professional athletes do not have the luxury of such intensive observation and performance monitoring…unless, of course, the therapist puts on a dive mask or goggles and watches closely with their head under water. Granted, some observations can be made by either the trainer or therapist from above the water’s surface. However, the added benefit of underwater observation can improve the outcomes. If not, sidewall windows in therapy pools would not be created with outside video cameras transmitting or recording the movements within.

Finding an aquatic therapist who is willing to get into the water and observe under the surface can be one’s best investment in personal aquatic programming as well as possibly insure the best possible outcomes for the participant. In many cases of aquatic therapy, it is not reasonable or justified to have a physical therapist treat patients on the same day he or she works as an aquatic practitioner. After all, their time is billable hours and transitioning from land to pool and back again is valuable billable hours lost. Aquatic therapy associations can do more to benefit participants and promote best possible outcomes by lobbying for changes in both insurance coverage and licensing for their members.

Another consideration for programming is music. In many therapy settings, a background accompaniment of soothing music can enhance the experience, aiding in relaxing the participant and helping to center and focus the mind. Quiet times in natatoriums are a rare occurrence in some facilities hence the use of soothing music necessitates the quiet environment.

Physical therapy practices that have therapy or warm water pools are far more likely to have opportunities for quiet times as well as access to sound systems and music that fit the therapeutic objective. Community pools, YMCAs and other athletic clubs are not likely to provide such experiences, except at some limited or designated times.  However, many physical therapy practices do not have pools, largely because of the expense. They may only offer aquatic therapy using other facilities where the noise must be tolerated, and therefore cannot offer therapies in quiet classroom formats.

When considering aquatic therapy, programming is one component of the total experience that needs consideration. The skills and credentials of the practitioner, along with the features of a facility, make aquatic programming play a significant role in the participant’s decision to pursue one of the most effective means of self-care currently available in 21st century America.

Felecia Fischell is an Aquatic Specialist with twenty-three years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor at the Franklin County Family YMCA in Virginia. Formerly the Founder of FunLife Aquatics Consulting in Maryland, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard County Community College.