Pooling Resources for Sports Medicine

Water is an excellent medium for treating orthopedic injuries and gets athletes back in action sooner.

By Mindy W. Toran

WHEN OLYMPIC FIGURE SKATER NANCY KERRIGAN WAS INJURED BEFORE THE 1994 Winter Olympics, she traded her workouts on cold, hard ice for rehab sessions in a warm therapy pool. While Kerrigan isn't the first athlete to discover the benefits of aquatic therapy

for sports injuries, she's one of many who's experienced water's healing power.

"Water is a superb medium for treating orthopedic conditions, and allows people to perform nonweight-bearing exercise, while stretching their joints and ligaments," says Marc Rabinoff, EdD, professor of human performance, sports and leisure studies at Metropolitan State College of Denver. "It also allows for the least amount of trauma during the rehabilitation process."

But those aren't the only reasons the evolving concept of aquatic therapy scores big in sports medicine. Professional and recreational athletes--particularly those involved in contact sports and who perform weight-bearing activities, such as skaters, skiers, football players, triathletes and dancers--may find that injuries heal faster with water therapy. This is due to improved circulation and the natural stretching of muscles, which creates more space between joints and relaxes muscles, Dr. Rabinoff explains. Water also helps reduce inflammation around injured joints, allowing the area to be exercised much sooner. And the soothing, relaxing powers of warm water put many patients at ease, allowing them to focus on their abilities, rather than limitations.

The main sports medicine goals of aquatic therapy include:

* strengthening muscles

* building endurance

* restoring range of motion

* enhancing gait training

* improving general conditioning

* instructing proper body mechanics and exercise techniques

* transitioning to land-based therapy.

Strengthening and training can be done earlier than land-based rehabilitation because buoyancy, which decreases stress on muscles and joints, promotes healing, explains Laurie DeSort, assistant director of rehabilitation services at Lake Forest Hospital in Lake Forest, Ill.

The water is also ideal for endurance and postural training, says Allen Ling, MPT, president of Physical Therapy Innovations in El Cerrito, Calif. Specifically, clinicians can use it for post-operative orthopedic injuries, cumulative trauma injuries experienced by athletes from improper form or overtraining and cross-training.

"The key is to get people moving without pain, which is often very exciting for patients--especially athletes, who are used to hurting much of the time."

Aquatic therapy also provides psychological benefits, adds Debbie Anderson, PT, president of Pacific Water Sport Physical Therapy Inc. in Carlsbad and Vista, Calif., and Mission Beach Water Sport Physical Therapy Inc. in San Diego.

"Water therapy creates a relaxing environment that people feel comfortable in," she says. The weightlessness created by the water reduces patients' pain, and allows them to monitor their own resistance. And, by feeling they can do something for themselves, rather than focusing on what they can't do, water therapy promotes quicker progression through rehabilitation, she says.

Equipment and Exercises

As with sports, equipment plays a big role with aquatic therapy when treating athletes. Aquatic therapists often use a combination of simple tools to promote balance or increase resistance. These include kickboards, foam dumbbells, hand floats, ankle cuffs, fins, paddles, webbed gloves and flotation vests.

With or without these tools, aquatic exercises seek to stimulate normal movement patterns with the appropriate joint stabilization. Increasing the person's range of motion through water therapy helps prepare him for more active land-based exercises. In addition, water workouts help maintain cardiovascular and muscular endurance.

Typical in-water exercises include manual stretching, mobilizations and restrictive exercises; deep-water walking; sit-ups; twists and turns; the vertical breast stroke and jumping jacks. Athletes can perform these exercises with help from an aquatic therapist, individually by the patient with 'on deck' coaching from the therapist, or with aquatic devices.

"The key is to regain range of motion, strength and flexibility to get the individual back to full function as soon as possible," says Robert Babb, PT, vice president and director of physical therapy at the Center for Aquatic Rehabilitation in Philadelphia and Cherry Hill, N.J., where golfers, bikers and runners are treated for back, neck, knee, hip and other orthopedic injuries.

It's also important to discuss the patient's goals early on, since "mutual goal-setting is critical to getting the individual back to the optimum level of function they're aiming for," he stresses.

Reducing Pain

Taking aquatic therapy to a deeper level is Igor Burdenko, PhD, president and founder of the Burdenko Water and Sports Therapy Institute in Lexington, Mass. Burdenko combines deep water, full-body aquatic therapy with land-based therapy--the key to developing balance, coordination, flexibility, strength and endurance during rehabilitation, he says.

"In the water, people have more energy because they escape gravitation," says Burdenko, who coached Nancy Kerrigan through her rehabilitation. He stresses the need to keep the patient in a vertical position by using a special flotation vest to loosen and relax muscles and increase blood flow, thus improving circulation to the injured area. The Burdenko Method includes rehabilitation, conditioning and transitioning to pre-injury functions.

"Aquatic therapy aims to reduce pain and prevent further injury," says Burdenko. "The old notion of 'no pain, no gain' is not beneficial."

Instead, he says the approach involves educating patients on how to move gracefully through proper posturing, and move efficiently by developing muscles, with safety in mind. "It's much easier to prevent an injury than to cure one," he adds.

Of course, athletes must be comfortable with the water to use it effectively, adds DeSort, warning that an aversion to it will impede therapy. Therapists must also be comfortable--with their knowledge of aquatic principles, that is.

"Using water as a medium for therapy requires different standards of care," says Dr. Rabinoff. "It's important that the therapist understand range of motion issues, biomechanics and kinetics [as they apply to water]."

This knowledge allows therapists to provide the rigorous training and rehab that athletes need to advance from the pool to the playing field.

"These individuals greatly benefit from a more aggressive approach to rehabilitation," says Babb. With this in mind, "aquatic therapy serves as a motivational tool for many athletes, both professional and recreational."

Mindy W. Toran is a freelance writer from Huntingdon Valley, Pa.