13 aquatic therapeutic exercise. benefits and purpose of aquatic therex exercise sometimes possible...
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13
Aquatic Therapeutic Exercise
Benefits and Purpose Benefits and Purpose of Aquatic Therexof Aquatic Therex
Exercise sometimes possible sooner in water than on dry land
Non weight bearing
Offers total exercise program: cardiovascular conditioning, flexibility, strength, muscular endurance
Specific GravitySpecific Gravity
Also called relative density
Specific gravity of water = 1
Ratio of an object’s weight to the weight of an equal volume of water
Average specific gravity for body = 0.95-0.97
For human body, depends on lean and fat mass and distribution of body fat
Archimedes principle: A body partially or fully immersed in a fluid will experience an upward thrust of that fluid that is equal to the weight of the fluid the body displaces.
BuoyancyBuoyancy
Archimedes principle
If body has specific gravity of 0.95, 95% of body will be submerged and 5% will float
A body with a specific gravity of less than 1 will float because weight of water displaced is less than weight of body
Center of BuoyancyCenter of Buoyancy
The center of gravity of the displaced fluid and the point at which the buoyant force acts on the body
When in equilibrium, the center of buoyancy and the center of gravity are in vertical alignment with each other and the body is balanced
HydrodynamicsHydrodynamics
Viscosity
The resistance to movement within a fluid that is caused by the friction of the fluid’s moleculesInfluenced by cohesion, adhesion, surface tension
(continued)
HydrodynamicsHydrodynamics
Drag: the water’s resistance to a body that is moving through it
Form drag
Frictional drag
Wave drag
Hydrostatic PressureHydrostatic Pressure
Pascal’s law: Pressure from a fluid is exerted equally on all surfaces of an immersed object at any given depth
For every foot of submersion, water pressure increases by 0.43 psi
The more deeply the object is immersed, the greater the pressure
Positive impact on edema
Pascal’s LawPascal’s Law
Reprinted from Bates and Hanson 1996.
Weight Bearing in WaterWeight Bearing in Water
The more deeply the body is submerged, the less weight is borne by the lower extremities.
Females’ center of gravity is lower than males’: affects percentage of body weight borne at different depths.The faster a person walks in the water, the higher the weight-bearing percentages.
Weight Bearing in WaterWeight Bearing in Water
Reprinted from Harrison, Hillman, and Bulstrode 1992.
Aquatic EquipmentAquatic Equipment
Safety equipment
Resistive devices: used to increase muscle strength/endurance; increase surface area, require speed, add buoyancy or weight
Assistive devices: help stabilize body, maintain buoyancy, assist in motion
Cardiovascular devices
Indications Indications for Aquatic Therexfor Aquatic Therex
Pain, edema, muscle spasm, loss of motion, weakness, limited endurance
Maintaining cardiovascular conditioning or normal status of uninvolved extremities
Restricted weight-bearing status
AdvantagesAdvantages
Can be performed even if weight bearing is restricted
Buoyancy reduces joint compressive forces
Warmth of water can relax muscles, relieve pain
Reduces weight bearing while allowing muscles to continue to function properly in the gait sequence
AdvantagesAdvantages
Can promote body awareness and balance
Can be used early in rehabilitation program, helping to prevent deconditioning
Can relieve or reduce pain due to immobilization or edema
Precautions Precautions for Aquatic Therexfor Aquatic Therex
Fear of the water
Conditions such as diabetes, cardiovascular disease, seizure disorders
Medications
Ear infections
Never allow patient in pool unattended
Contraindications Contraindications for Aquatic Therex for Aquatic Therex
Contagious infection
Temperature of 100° F or more
Severe cold or flu
Urinary tract infection
Open wounds
Application Application of Aquatic Principlesof Aquatic Principles
Hydrostatic pressure: more advantageous to exercise swollen extremity in deep water
Greater resistance achieved through
longer lever arm, straighter extremity
increased speedmoving object at surface of water or with increased surface area
Aquatic Exercise Aquatic Exercise ProgressionProgression
Early
Use buoyancy equipment for increased range of motion.
Do gait training in deep water.Use resistance exercises without equipment.
(continued)
Aquatic Exercise Aquatic Exercise ProgressionProgression
Mid
Emphasize restoration of muscle strength and endurance.
Use drag to increase resistance.Add resistive equipment.
(continued)
Increase reps and sets.
Aquatic Exercise Aquatic Exercise ProgressionProgression
Advanced
Focus on restoration of ABCs of proprioception
Gait training more intense and varied
Hopping, jumping, etc.
(continued)
Eyes open, closed.
Increased intensity for strength
Aquatic Exercise Aquatic Exercise ProgressionProgression
End phase
Mimicking skills and demands of sport
Aggressive coordination, agility, speed activities
Plyometrics
Benefits Benefits of Deep-Water Exerciseof Deep-Water Exercise
No weight bearing and no impact forces
Forces of gravity on a submersed body are minimal
Can help maintain cardiovascular fitness and strength
Exercises essentially concentric
Correct Vertical AlignmentCorrect Vertical Alignment
Correct Position Correct Position for Deep-Water Runningfor Deep-Water Running
Refraction of LightRefraction of Light
Determining Depth Determining Depth of Waterof Water
Patient’s confidence in the water
Patient’s weight-bearing status
Goals of the exercise
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