- by Dr. Robert C. Martin

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Rehabilitation after an injury or surgery to the musculoskeletal system can be a lengthy and painful process. Many therapeutic modalities are utilized to speed up recovery and reduce the pain associated with rehabilitation exercises yet none has provided more widespread and dramatic benefits for musculoskeletal patients than the use of water.

Warm water pools allow for an earlier initiation of treatment 1 to 2 days following a sprain/strain and 5 to 7 days following surgery. This early initiation of water therapy allows the patient to maintain flexibility and strength in the joints adjacent to the healing areas, and to maintain or increase cardiovascular endurance. Utilizing the water medium for therapeutic exercise allows therapists to provide better treatment and to assist with quicker and less painful recovery for patients.

Aquatic therapy is not a new approach, but a revised approach stemming from therapists and physicians reevaluating ways to enhance and speed up patient recovery time particularly in the area of sports medicine. Using water for healing can be traced back to 800 BC England, where it was used to treat fatigue and heal injuries. Hippocrates (460-375 BC) taught water could be used as a tonic and a sedative. In later centuries, the Greeks and Romans recognized the benefits of a pool as an adjunct to their sporting activities. In the 1800s an Austrian professor founded the Institute for Hydrotherapy to study the physiological effects of hot and cold water.

In the last century most early water activities were passive, especially in America. As early as 1911, Charles LeRoy Lowman, MD, of Orthopedic Hospital of Los Angeles (now Rancho Los Amigos) transformed the hospital’s lily pond into two therapeutic pools. A freshwater pool was used for therapy with paralyzed and poliomyelitis patients, another pool was filled with saline and was used to treat patients with infectious diseases. President Franklin D. Roosevelt, whose legs were paralyzed because of polio, popularized the use of water exercise and therapeutic swimming. He was the first president to install a pool on the White House grounds.

From 1911 through 1950, water therapy was popular for treating the chronically ill, especially those suffering from cardiac, vascular and circulatory ailments. In the late 1950s, with the development of the polio vaccine, cases of polio dropped dramatically and water therapy became less prevalent. In the 1970s scientists again started to study the effects of weightlessness produced by water buoyancy on human physiology and they discovered many significant beneficial effects.

When immersed to the neck in warm (88-90 degrees F) water the hydrostatic pressure of the water enhances venous blood flow returning to the heart. This enhances the pumping capacity of the heart by one-third and reduces the resistance to flow in the arteries resulting in a doubling of blood flow to the muscles. This increased blood supply improves oxygen delivery to muscles and facilitates removal of lactic acid and other metabolites from the muscles. Patients also experience muscle relaxation due to increased blood flow and the neutral temperature of the water. The forces of buoyancy decrease the weight on joints allowing more functional movement during early rehabilitation without producing the pain brought on by moving the full weight of the extremity.

Currently, orthopedic surgeons, other musculoskeletal health providers and therapists are using the properties of water and its physiologic effects to help a wide variety of patients ranging from the elite athlete rehabbing a sports injury to an elderly patient recovering from a total knee replacement.