Transcription:
Aquatic Therapy: Optimizing the Effects of Buoyancy

Melanie Cole, MS (Host): Have you ever exercised in the water? I love the way it feels because it just makes your body feel lighter and more buoyant and it doesn’t hurt your joints. Well aquatic physical therapy is the same and there are so many benefits to it. My guest today is Lydia Lytle. She’s a physical therapist with Aspirus Healthcare. Lydia, tell us about aquatic exercise in general and then we’ll get into some specifics about physical therapy in the water.

Lydia Lytle, PT, DPT (Guest): Sure, hi. Thanks for having me. So we have this new setup and we’re really excited to be able to provide aquatic therapy to the Keweenaw and the Houghton Hancock area up here. So aquatic therapy is wonderful in that we can strengthen or increase range of motion without adding increased sheer forces to the joints. So there's a lot of patients who would benefit from this. I mean anybody who has any sort of osteoarthritis, who has pain with increased impact, or spanning all the way across to maybe even neurological conditions. If somebody’s had a stroke or they have had a traumatic brain injury or a spinal cord injury, the water gives them a lot of freedom of movement while also offering them a safe place to exercise and get stronger in order to move back on to land.

Host: So tell us a little bit more while we’re on the subject about the new setup. People wonder. They’ve heard of water treadmills and they’ve seen the bars on the steps, but what does a setup for an aquatic physical therapy look like?

Lydia: Sure. Well every setup looks differently. So we don’t have our own setup here in the clinic because we’re able to partner with the American Pool. So the American is allowing us access to their pool, which is an 88 degree pool with a lift to get you in and out if you are unable to move up and down the stairs. They also have other facilities like their hot tub and their sauna, which some people are attracted to. They also have wheel chair accessible bathrooms and shower facilities. So it’s a way that the community has access to this great resource.

They also provide aquatic swimming, therapeutic swimming, which is apart from aquatic therapy. So it’s a nice transition from us going from aquatic therapy with myself into more of a “home based”—even though it’s not at home—therapy program where they could continue exercising on their own at the pool. So it offers a great transition for patients, especially if they do want to continue aquatic exercises independently.

Host: As people, we live and walk on land. Tell us why we should be exercising in the water.

Lydia: Sure. I hear this question all the time. Why should we be exercising in the water if we move and live on land? We don’t live in the water. So why should we exercise in the water? Well, I think water holds healing benefits intrinsically. So as humans, we’re made of water. We’re attracted to water. We enjoy swimming. We feel good when water is around, which is one of the reasons why we live in the Keweenaw Peninsula surrounded by Lake Superior. So I think inherently water is good for us.

Now aquatic therapy versus land therapy, water can provide us the ability to transition really well. So let’s say someone is non-ambulatory. So they're using a wheelchair to get around. Let’s say they’ve had a car accident, or they’ve had a spinal cord injury of some sort or they’ve had a stroke, or even they have rheumatoid arthritis and they're in a flareup and they're unable to stand. Or somebody who has multiple sclerosis. So there’s lots of reasons that someone may not be able to move efficiently on land. In the water, we’re able to get them in and get them moving just as they would on land. So we have people who are unable to walk, but we get them in the water and they're able to jog or run. That’s pretty incredible.

Then through those water exercises, we move gradually through them. They regain the range of motion in their joints. They regain their strength. They regain their confidence with balance. Then we’re able to transition them back onto land successfully. Then we can continue with land therapy after that as well. It does give them the tools to succeed as they move back onto land.

Host: Tell us what types of exercises or treatment styles that you're using in the pool.

Lydia: Sure. So every single patient is going to have a completely different setup for their exercises. We can be really creative. We can use things that float. So in the water, the buoyancy is going to allow our bodies to move to the top of the water, right? So if we add a weight, the weight is not gonna feel the same outside of the water as it does inside of the water. So we tend to use things that float in order to push against the buoyancy of that water. That is our resistance. So we can do things on the surface of the water against surface tension and moving back and forth with arms or legs. Or we can be under the water and add some weight and we can get some traction through joints.

But we also use a couple of techniques specifically called Bad Ragaz, which is the circular method of moving the extremities and it increases range of motion. I also use a technique called Watsu, which is a relaxation method and it increases the range of motion in each of the joints as well in these circular patterns where the patient is floating. I have to have a really good rapport with the patients when we do this because I'm in very, very close proximity to them. I'm holding them on top of water as we move back and forth. Patients always end that session saying, “Oh my gosh. I can't believe how good I feel.” I think it’s the water that’s really doing the work there. But yeah. We have a bunch of different opportunities with the pool and we can get really creative and specialize it to whatever the patient needs.

Host: You did just give us a little bit where someone said, “Oh my gosh I feel so much better.” Tell us about some of outcomes and responses that you're seeing from patients in response to how it makes them feel in the longer term, Lydia.

Lydia: Sure. Sure. So one patient example, I had a patient then who has had chronic low back pain for years and years. The treatment options for their low back pain are very, very limited. They're not able to take pain medications and they are not able to get surgery because of multiple other factors. A back brace does not do much for them and we've tried land therapies two to three times without success because the back flares up and gravity takes hold and it causes them to stoop forward.

So when I started aquatic therapy, it was just at the time that I was starting to see this patient again. I said, you know what? I think we need to get in the pool. So we got this patient in the pool seeing them once a week and this patient has said that there pain has dropped—On zero to ten scale, zero is no pain, ten is extreme pain, they’ve dropped consistently from a seven out of ten to a four out of ten throughout the entire day. That’s pretty incredible for multiple years of chronic extreme back pain to have that significant of a drop. So that’s just one example—because I think a lot of people can relate to back pain—of the benefits of aquatic therapy. We’re able to get him on his back. We’re able to do mobilizations, like spinal mobilizations, in the water so that there’s not a lot of force on the back.

But there’s a variety of conditions that I've treated in the water and that patients present with. We have people coming out of car accidents with multiple breaks to multiple areas of the body. On land, it’s more difficult to treat those multiple areas at the same time. In the water, we have the hydrostatic pressure on every single one of the joints. So with every single movement that that person is doing, they are getting a therapeutic effect of water. So I can work on multiple joints at one time and the patient’s going to get a really great benefit out of the water.

Host: Wow. You know what a great way to work out. For physical therapy, as you say Lydia, it’s so, so helpful. What about just as a basic way to exercise? People use to think of aquatic exercise, when I taught it anyway, it was like little old ladies in a bathing cap. But that’s not really the case anymore, right? I mean you can get a really great workout. Speak about aquatic exercise and the big question that everybody always wants to know. Are you really burning fat? Are you getting your heart rate up? Is it at good as other forms of exercise?

Lydia: Well sure, sure. So there’s—I guess going back to what you said about little old ladies with swim caps on. There’s a whole spectrum, right? There are benefits to, as my grandmother calls it, the aqua babe groups. They meet two to three times a week and they move around in the water. I think that can be extremely healing in itself. Although it looks very different than what other people partake in as more lap swimmers where they’re getting their heart rate up a little bit higher. Maybe they're even putting their face in the water so they’re having to hold their breath, which is also going to cause their heart rate to go up a little bit higher. The spectrum is great, but I think both groups are going to be getting benefits.

Now with aquatic therapy, what I like to do is teach the patients what exercises we’re doing and how to do them independently so that when they do transition out of therapy, they are able to use those same tools in the water. So they're not just going to be bouncing or moving around in a random fashion. They're going to know exactly what’s going to benefit their body the best. Generally, I think people do benefit from being in the water and moving around in the water, like I said, because of the increased resistance on every single one of the joints and areas of the body. So they are going to be strengthening even without trying when they're in the water. As far as heart rate and burning fat, you do have to reach a certain heart rate. You don’t want to be at your heart rate max when you're trying to burn fat. But certainly talk to your physician about safe levels for you to be exercising at, especially if you have heart history is what I would suggest.

Host: That’s great advice. Wrap it up for us. What would you like the listeners to take away and know about aquatic physical therapy, the setup that you have there with Aspirus, and why they should consider coming there for their therapy?

Lydia: Sure. I think one of the best things about aquatic therapy is the variety of people that I can help with. So I like to use one example. From down state, there’s an aquatic therapy area that has reached out to the local counseling services. They're providing aquatic therapy to women who have a history of physical abuse. That is not a typical area of therapy that you would associate with. So what they're doing is they are reintroducing a healthy and positive way for these women to be able to physically contact another person. So that’s pretty incredible. We tend to think on the lines of orthopedic conditions. So let’s say somebody has a post-op hip and they are having decreased mobility. It’s hard for them to walk around. Certainly we can get those people in the water and we can get them moving.

But the spectrum is huge. So going all the way from orthopedic conditions to children with neurological conditions to adults who’ve been through a stroke or people who are in a wheelchair and maybe who have just simple balance issues. All the way to areas that might influence their psychological behaviors and their ability to reenter society in a healthy way. So I think the great thing about the water is the general ability for water to heal and how many people that that can reach.

Host: It’s so important and what a great feeling it is to do your therapy or do your exercise in the water. It really does put a whole new light on exercise and how it feels to do your physical therapy. Thanks, Lydia, for coming on and sharing your expertise with us today. This is Aspirus Health Talk. For more information, please visit aspirus.org. That’s aspirus.org. I’m Melanie Cole. Thanks so much for tuning in.