Water is the safest and most complete setting to correctively rehabilitate and strength-train a person. As a specialist in strength and conditioning and corrective exercise who studied biomechanics at California State University-Fullerton, I've seen first-hand the rehabilitation and physical therapy it takes to better a person's quality of life.
Whether I'm working with an athlete or a barely mobile elderly person, I understand the benefits of bearing weight and perfecting our mechanics while training on land. But I've found that these same techniques are vastly improved when performed in warm water.
Aquatic training, in conjunction with traditional land-based strengthening and endurance programs, can elevate an athlete's conditioning program faster and more thoroughly than land training alone.
Being committed to mixed martial arts for the past decade has broadened my understanding of the physical capacity and limits of the human body. I've competed with some of the strongest and fastest MMA fighters in Orange County, many of whom will soon be in the Ultimate Fighting Championship.
I know what unnecessary torque and pressure can do to someone's joints and musculoskeletal system for years to come. I've also experienced what injury recovery really entails. This is why I state that every patient, even the highest-level athletes, can benefit from aquatic use for strength training and physical therapy.
Hindrance is Not Resistance
While loading our bodies on land is definitely the fastest way to strength gains, there are always aspects of strength and endurance that only a constant body of resistance, such as water, can deliver.
Working with torn ligaments, joint impingements and extremely deconditioned muscles, it's not that difficult to predict that injuries can result. Solving the problem of an injury entirely, both for myself, my clientele and the fighters I train with, is a challenge because dry-land exercises only go so far.
The warm deep water element turns basic therapeutic exercises performed on land into a complete healing procedure for anyone. The buoyancy of water releases pressure throughout multiple joint capsules and allows for a variety of resistance from the lever arm having to move through water.
Warm water will place patients into phase 1 of their passive warm up. By submerging an athlete in a warm pool, we can increase blood flow and proper circulation to any affected area that needs to be specifically treated, as well as get adequate oxygenated blood pumping through the body.
The viscosity of water also creates a constant, yet comfortable, level of resistance without introducing additional weight on the body, joints and muscles. The hydrostatic pressure improves functional mobility as quickly and as pain-free as possible.
Water also remains a persistent drag force on our every movement, creating diverse angles of resistance, while also heightening the patient's proprioceptive awareness. Conversely, it's far more difficult to have a person exercise an injured area comfortably and focus on joint position awareness on dry land.
Water is a necessary addition to anybody's training regimen, and is vital for the overactive as well as the underactive patient. Yet in my quest to provide more accessibility to warm aquatic therapy, I've found that providing it is not as easy nor as available as I'd hoped.
Fortunately there is a variety of consumer-friendly designs on the aquatic therapy and training market that are both durable and customizable to fit commercial needs. Also, local in-ground pools, professional therapy pools, and a variety of spas bring more options to therapists and sports medicine professionals.
While some aquatic therapy options are too expensive for the average user, or in the case of spas, too limited in space and depth, others provide a convenient way to offer deep warm water therapy to my clients.
Mark Elmasry is a certified aquatherapist and certified strength and conditioning specialist in California.
Buoyancy. When a patient is submerged to the waist in water, up to 50 percent of body weight is supported. For example, a 150-pound person would have approximately 75 pounds of body weight supported in waist-deep water. When a person is submerged neck-deep in water, the percentage of supported body weight increases to around 90 percent. Buoyancy can decrease the stress placed on injured joints and muscles, allowing patients to exercise more efficiently and with less pain.
Hydrostatic Pressure. The external pressure exerted on the body by water helps increase the efficiency of the circulatory system. This increase in blood flow results in increased oxygen and nutrient delivery as well as increased waste product removal, all of which help promote healing. Another advantage to increased circulation and blood flow is decreased swelling in lower extremities, which can aid range of motion and help speed recovery.
Temperature. Therapy pool temperatures range between 92 and 96 degrees, allowing blood vessels to dilate and blood flow to increase, helping muscle tissue to relax. This warm temperature may also help to reduce stress or anxiety.
Resistance. The resistance of water is much greater than the resistance of air, so patients who exercise in water use many more muscles and have much stronger contractions than they would when exercising on land. Water resistance is also unique because it can be felt in all directions of movement. The intensity of the movement (strength of resistance) can be altered by increasing or decreasing speed or by using equipment such as weights or floats.
These components working together, when initiated early in rehab, can decrease recovery times and help make rehabilitation a less painful and more enjoyable experience.
-John Mishock, PT, DPT, DC, and Melissa Bennett, ATC