What is hydrotherapy?

Hydrotherapy (aquatic physiotherapy) is a type of therapy used by specially trained physiotherapists in a warm pool. A hydrotherapy program can include:

• specific exercises and movements with some help from a physiotherapist or an assistant
• exercises that you can do on your own in the pool
• individual or group sessions.

Hydrotherapy is different from swimming and water aerobics as your physiotherapist will give you a program of special exercises. These exercises are designed to help you with your main areas of difficulty, for example, tight muscles or balance problems. Most exercises are done standing in chest-deep water or using equipment to float in the water.

It is important to teach children to be safe in the water. “Training in swimming techniques and stroke correction may not be appropriate. Adaptations and modifications to strokes are often needed” (Reference: Montrose Access: Duchenne Muscular Dystrophy: A Team Approach to Management. 2011. Funded by NSO (Specialists: Disability Support in Schools)).

The water temperature of a hydrotherapy pool is usually around 34°C which is warmer than a regular swimming pool. Pool access also needs to be considered and will usually have a ramp and a hoist available for entering or exiting the water.

How can hydrotherapy help with my neuromuscular condition?

There are several properties of water which make hydrotherapy a unique experience, including:

• buoyancy, which is the opposite force to gravity. This means that being in water reduces weight-bearing forces through the body, making it easier to walk. Other effects of buoyancy include it offers support for weakened muscles, improves flexibility and range of motion and makes manual handling easier for the therapist or support worker. [1]
• hydrostatic pressure, which is the force exerted on your body by the water. It works to reduce pain and swelling and to improve circulation.
• when combined, hydrostatic pressure and buoyancy will give the feeling of weightlessness. [2]
• water also has properties of viscosity which is the term that describes a fluid's resistance to flow. [3] The higher viscosity of water makes muscles work harder when you are moving through the water compared with doing the same movement on land. Depending on your type of muscular dystrophy and the aims of hydrotherapy, this resistance can be used to improve muscle tone, improve cardiovascular fitness and to progress activities by increasing or decreasing the speed of the movement. [4]

Hydrotherapy also has both physiological and therapeutic effects.

Physiological Effects

Physiological effects occur from both the temperature of the water, the amount, type and extent of exercise, and the length of the session. They include, increased blood supply to the muscles, and increased body temperature due to the body gaining heat from the water and from the contracting muscles. [5]

Therapeutic Effects

Hydrotherapy can help people with neuromuscular conditions in different ways: [6]

• The warmth of the water and the feeling of being weightless can relax muscles and help stretching.
• The buoyancy and support of the water can allow you to move more freely, and with less worry about falling, than on land. Balance activities can be performed in a ‘safe’ environment where you will not hurt yourself if you lose your balance and fall.
• Water can provide resistance when you’re moving. By pushing your arms or legs against the water, or moving quickly in the water, you can strengthen muscles.
• Water can also provide for good active exercise which is low load and where muscles work concentrically. [7]
• There are positive effects of exercise such as increased stamina, endurance, fitness and weight control.
• Breath control can improve lung function.
• The warm water can assist with relaxation and stretching.
• Hydrotherapy can help build self- esteem and improve social contact and opportunities when performed in a group setting.

Are there any risks?

Hydrotherapy is not recommended for some medical conditions, due to the warmth and pressure of the water. If you have respiratory muscle weakness the pressure of the water around your chest may make it more difficult to breathe, and the depth of the water and level of submersion must be considered. Your physiotherapist will ask you about your medical history before you start to make sure hydrotherapy is right for you. You may also need to get clearance from your doctor or specialist.

Your physiotherapist might suggest different equipment or exercises to ensure you are safe when you are in the pool. For example, if you have weak neck muscles, being on your tummy in the water is difficult, and floating on your back or being upright is preferred. A collar positioned around the neck can make it easier.

Although you do not need to know how to swim to do hydrotherapy, you do need to be confident moving around in the water. Your physiotherapist may recommend some one-on-one sessions if you are scared or worried about being in a pool.

Exercising in warm water can make you feel very tired so try to plan time for a rest afterwards and remember to drink plenty of water to stay hydrated.

How do I get started?

Talk to your physiotherapist or specialist about hydrotherapy in your area. You could also contact your state or territory neuromuscular organisation. Before you undertake a hydrotherapy program, you will need a physiotherapy assessment on land. Your program will be devised to suit your specific abilities and individual goals and may need to be changed as your ability to move or float changes.