Clinic owner discusses the benefits of aquatic therapy for a variety of patients and conditions

By Brian W. Ferrie

It would be difficult to find a more authoritative source on aquatic therapy, or stauncher advocate of it, than Robert Babb, MBA, PT.

A physical therapist since 1990, Babb had previously served as a physical therapist assistant in the U.S. Navy, which had an extensive aquatic program. After graduating from physical therapy school, he worked for 12 years as a practicing therapist and chief operating officer at the Centers for Aquatic Rehabilitation, with locations in northeast Philadelphia, Bala Cynwyd, PA, and Cherry Hill, NJ.

In 2002, Babb founded the Physical Therapy & Wellness Institute in Lansdale, PA, a full-service clinic with a prominent aquatic therapy component. The second branch of the institute, located in Quakertown, PA, just opened on Oct. 3.

Common Treatment

"I would say that 35 percent to 40 percent of our patients [at the Lansdale facility] receive some type of aquatic therapy as part of their treatment," Babb told ADVANCE.

That facility features two therapeutic pools, one with a lift and one with a ladder. Both are heated to about 94 degrees Fahrenheit, which is considered ideal therapeutic warmth to create vasodilation at the peripheral joints, noted Babb.

"The pools are each eight-feet deep, for the unloading principles, and we practice a lot of buoyancy-unloaded exercises with patients," he commented. "Aquatic therapy in general is a key modality in what we do."

Babb expects to emphasize aquatic therapy to a similar degree in the new facility, once the pools are installed. The Quakertown facility, converted from a house, will have an addition built starting in February and will include two pools. The first one will be shallow, three-and-a-half to four-feet deep, while the second will feature the same eight-foot depth as the two pools at the Lansdale facility. Babb expects the addition to be completed by late April.

Injuries and Conditions

"We use the aquatic therapy facilities at the Lansdale location for athletic injuries, joint replacements, neck and back pain, pretty much anybody who's limited with weight bearing," he said.

Many of the patients who receive aquatic therapy at the facility are local high school athletes, particularly football and soccer players.

"With that population, a lot of times you're looking at a medial collateral ligament (MCL) sprain. First we'll sit them down for three to five days, maybe mobilize them a little bit, work them with modalities, and do manual techniques on the knee. But we don't want a whole lot of movement as the MCL is starting to heal. Then when we get to the third to fifth day, if it's a grade 1 sprain, we'll start to get them moving, and the water is an ideal setting to do that."

Maintaining Fitness

One of the benefits of the aquatic environment is it allows athletes to maintain cardiovascular fitness without significant stress on the joints.

"A lot of times I'll have the high school players run hard in there for a level of conditioning," Babb commented. "So we're [exercising] the joint in a buoyancy-unloaded environment. I'm also getting their heart rate up so that, cardiovascular-wise, I'm keeping them at a high level where they can get back to the field in the same condition. It's a great way for some of the high-level athletes to keep their level of conditioning without the pounding on the joints."

The typical soccer player rehabbing a grade 1 MCL sprain with the help of aquatic therapy can return to the field in 2-4 weeks, said Babb. At that point, the athlete can certainly continue to do strengthening exercises on his own at home, but the aquatic therapy component would no longer be necessary.

Basketball injuries are another type Babb encounters in his clinic that are appropriate for aquatic therapy.

"We'll see some basketball injuries, but more so with [middle-aged] men as opposed to high school athletes. I'm involved myself in playing basketball at some of the local churches, so I've gotten to know many of these people. They come in with ankle sprains and some knee strains too. They'll get in the water and we'll give them a good workout in there as well."

Properties of Water

Babb was asked to describe what qualities of aquatic therapy make it so effective in the treatment of a variety of injuries.

"I'll use it in several ways," he responded. "Some of the principles of the water itself impact how I make clinical decisions. For example, if there's inflammation in the joint, I like to use the deep water for the hydrostatic pressure because I know it can decrease swelling and reduce the stress of the joint. I also like to use the viscosity of the water for resistance. For the same athlete who goes in the water for therapy, I can use that to my advantage simply by asking him to give me a 10 percent greater effort because his heart rate isn't high enough."

The buoyancy creating the unloaded environment can also be very helpful for conditions other than athletic injuries.

"It's terrific for people who present with neck and back pain. I'm unloading them and taking away compression and shearing on any of the lumbar spine or cervical spine segments. I also get people with fibromyalgia or degenerative joint disease who haven't been able to get on a treadmill, elliptical machine or exercise bike. But we can get them in the water in that environment and they come out and say, 'I feel great. That's the first time I've been able to do something [active] in a long time.' So it's a great medium to get them moving."

Furthermore, as members of this population begin to understand what they can accomplish in the water and on an exercise mat, Babb often tries to get them involved in a community-based program to maintain benefits over the long term.

Typical Session

A typical aquatic therapy session for most patients at The Physical Therapy and Wellness Institute lasts 25 to 30 minutes, out of a 60-minute overall therapy session.

"We might start them at 20 minutes, but 25 to 30 is where we max out," Babb explained. "We really want to get them up on one of the tables and go over functional exercises with them. If it's a person with a knee problem, we work manually on the knee up on the table, or we'll work on the ankle if it's an ankle injury. We may put some pneumatic compression on it and ice after they're done running in the water, to make sure it doesn't swell up. That way, when they go back to the training room or the field that afternoon or the next morning, they're still doing OK."

For some of the older patients, on the other hand, Babb said he might go over balance techniques.

"I have deep water right now [in the two pools at the Lansdale location]. If I had shallow water [like one of the two pools at the Quakertown location will have], one of the best things to do is use the viscosity and turbulence of the water to get people in a position where they're a little unsteady and their balance is challenged. We can do it dynamically when they're walking, narrow or widen their base of support and see how they respond. It's a great way to work balance. Since I can't do that right now, we'll bring them on land instead and work on balance techniques there."

Various Benefits

Overall, Babb was very enthusiastic in his praise of aquatic therapy and the various benefits it can have for a variety of patients.

"I think generally speaking, aquatic therapy has been a terrific medium," he concluded. "It's a great tool for therapists to get people active at an earlier phase and to get people active who have not been active in the past, such as some of our geriatric patients. Once I get them in the water and build their confidence, we can get them on land and back to the community. Joints were made to move. The more you move a joint, the more you flush the end of the joint with the normal synovial fluid that's in it, the better the joint will feel. So it really helps me a great deal to get these people moving in an environment that takes away the compression."

Brian W. Ferrie is on staff at ADVANCE and can be reached at bferrie@merion.com