Jennie Clark, PT, with Baptist Sports Medicine works with patient, Orlando Covington, at the Maryland Farms YMCA pool. By placing light weights on Orlando’s ankles, they are able to do walking excercises, despite Orlando’s back injury.

Transition to Land Exercise Still the Goal

Aquatic therapy, pool therapy or hydrotherapy … no matter what you call it, this form of physical therapy is a critical rehabilitation tool for some patients in pain and a welcome option for many others.

According to the American Physical Therapy Association, many orthopaedic, neurologic and cardiovascular/pulmonary conditions can be treated effectively

using the unique physical properties of water. Water also is a low-impact setting conducive for preventive and wellness activities.

An aquatic environment offers:

• buoyancy, which reduces stress on the joints;
• viscosity, which provides resistance when exercising; and
• hydrostatic pressure, which decreases swelling and helps patients better position their joints during therapy.

Jennie Clark, senior physical therapist at Baptist Sports Medicine, said she finds aquatic therapy “a wonderful option” for many of her patients. She added that it’s particularly effective for patients suffering low back pain. “The reason the water works so well for these people is because the buoyancy of the water helps support the body so there’s less pressure on the back,” Clark explained. “Then they can exercise for longer periods of time and actually really be able to work their muscles, work their legs and work their stomach to support their back without having the force of gravity creating pain in their back.”

For patients with arthritis, “the water is also a very supportive environment, which helps facilitate the movements,” Clark said. That’s because, without the force of gravity creating compression on the joints, the joints move more freely, she noted.

Clark practices at the Baptist Sports Medicine facility at the Maryland Farms YMCA in Brentwood. BSM also offers aquatic therapy at its locations at the Gordon Jewish Community Center on Percy Warner Boulevard and on the Baptist Hospital campus downtown.

“I’m in the pool every afternoon for two hours,” Clark said. She believes aquatic therapy is an ideal option for core strengthening, yet for aquatic-therapy patients, “co-therapy” is usually the best alternative. That’s when aquatic therapy is combined with therapy on land. Treatment begins with three weekly sessions in the water. Eventually, patients transition to two water sessions and one land session, then one water session and two land sessions. Clark said the goal is to transition them out of the water completely, yet she does recommend continued water exercise in the long term for a few of her patients.

“Sometimes it’s a push to get them out of the water,” she acknowledged.

It’s that challenge that has prompted another physical therapy provider to move away from aquatic therapy. Headquartered in Franklin, Results Physiotherapy has 34 locations across Tennessee. Four of its Middle Tennessee locations – Smyrna, Lebanon, Dickson and Winchester – offer aquatic therapy.

“We close pools, not open pools, so we’ve decreased our hydrotherapy presence. In fact, we just filled in a pool at our Brentwood location this year,” said John Nelson, Results Physiotherapy’s vice president of marketing and a physical therapist himself.

Aquatic therapy is “applicable or relevant when someone in pain can’t exercise on land,” Nelson said. Then he added, “It’s got its place, but at the end of the day, we all have to function on land. Part of our move away from aquatic therapy has been that we’ve improved our exercise program.”

Nelson described aquatic therapy as “a stepping stone for people who can’t exercise on land.” He also noted that “it’s not very practical” for patients who can’t access a pool after the therapy sessions are over.

Nelson said that in today’s healthcare economy, there’s a “downward pressure on reimbursements” for aquatic therapy. “It needs to be better reimbursed, as long as it’s applied in the right manner,” he said. “A well-structured reimbursement scheme for aquatic therapy makes sense, but the goal should still be to progress people to land because that’s how we function. We don’t walk around in a pool of water.”

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