the aquatic therapist

Accelerated Rehab after ACL Surgery Includes Aquatic Therapy

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Bridey-Lee Momberg, Quinette Louw, Lynette Crous. Accelerated hydrotherapy and land-based rehabilitation in soccer players after anterior cruciate ligament reconstruction:a series of three single subject case studies. SAJSM. 2008; 20(4): 109-114.

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Objective. To investigate the effectiveness of accelerated rehabilitation and accelerated hydrotherapy after anterior cruciate ligament (ACL) reconstruction in male athletes participating in soccer.

Design. A non-concurrent single subject, multiple baseline design (ABA design) was conducted over 10 weeks. A series of three N=1 studies was conducted to assess the effect of an accelerated hydrotherapy programme on pain, function, and range of motion.
Setting. The study was conducted at a private physiotherapy practice in Port Elizabeth, South Africa.

Interventions. The land rehabilitation programme was a homebased programme supervised every week by the physiotherapist. The accelerated hydrotherapy consisted of a 6-week programme, and participants attended two treatment sessions of accelerated  hydrotherapy per week each of 30 minutes' duration.

Main outcome measures. The knee injury and osteoarthritis outcome scale (KOOS) as a subjective measure of pain, function and quality of life; the goniometer to measure active knee ROM and the 6-minute walking test (6MWT) as an objective measure of function.

Results. All three patients demonstrated good improvement during the treatment phase for the KOOS scale and progressed well

CORESPONDENCE:
Professor Quinette Louw
Division of Physiotherapy
Department of Interdisciplinary Health Sciences
Faculty of Health Sciences
Stellenbosch University
PO Box 19063
Tygerberg 7505
Republic of South Africa
Tel: +27(021) 938 - 9301
Fax: +27(021) 931-1252
E-mail: qalouw@sun.ac.za
Bridey-Lee Momberg (BSc, MSc Physiotherapy (OMT))
Quinette Louw (BSc, MASP, PhD)
Lynette Crous (BSc, MSc)
Division of Physiotherapy, University of Stellenbosch

Read eSPLASH, the Aquatic Therapy Industry hotsheet

 
Nearly 5000 aquatic therapists get it every week. So why not you?

Here are just a few of the topics you missed...

12 Oct 2009: Billing for groups, WaterWay Babies, Multiple sclerosis and More!

21 Sept 2009: Medicare Denials, Swine Flu, TKR Proof, Adapted Showers and More!

14 Sept 2009: s/p TKR, Free CME, Grants for Pools, Pets vs. People and More!

7 Sept 2009: MRSA transmission, Neonatal hydro, HIV lawsuits and More!

17 Aug 2009: Vomit, Pool Yuck, Baby Asthma and More!

3 Aug 2009: Lower Back Pain, Blind Aquatic Therapy, Preschooler Pool Sessions and More!

Click here to read all the archives... or to sign up to get the hotsheet emailed directly to you every Monday.

Free education on aquatic rehab for TKA, Cardiac rehab, Mental health and more

In the mood for a freebie or 2? Attend the following seminars online for free courtesy the National Swimming Pool Foundation!

Health Benefit Track

Cardiorespiratory Fitness and Coronary Heart Disease Risk Factors in Women and Men Swimmers ~ Steven N. Blair, P.E.D., University of South Carolina (view abstract & bio)	Watch this seminar!
Exercising the Mind: How Water-Based Exercise Can Improve Mental Health ~ John "Jack" S. Raglin, Ph.D., Indiana University (view abstract & bio)	Watch this seminar!
Aquatic Exercise for Better Functional Activities on Land ~ Mary E. Sanders, Ph.D., FACSM, University of Nevada – Reno/WaterFit (view abstract & bio)	Watch this seminar!
A Comparison of Water and Land Therapy Versus Land Therapy on the Outcome of Total Knee Arthroplasty ~ Richard McAvoy, PT, DPT, CSCS, Rehab 3 at Marshbrook (view abstract & bio)	Watch this seminar!
Cool, Warm, and Hot Water Immersion Effects on Cardiac and Circulatory Function ~ Bruce Becker, M.D., M.S.; Kasee Hildenbrand, Ph.D., Washington State University (view abstract & bio)	Watch this seminar!

Plyometric training in water produces better results... with less stress to the athlete

Triplett NT, Colado JC, Benavent J, Alakhdar Y, Madera J, Gonzalez LM, Tella V. Concentric and impact forces of single-leg jumps in an aquatic environment versus on land. Med Sci Sports Exerc. 2009 Sep;41(9):1790-6.

PURPOSE: This study investigated the kinetic and the kinematic differences in female athletes in single-leg static jumps in an aquatic environment compared with those performed on dry land.

METHODS: Twelve healthy, junior national team handball players participated. Subjects completed a familiarization and a testing session. The subjects performed a series of single-leg jumps, dry land and aquatic with and without devices, which were randomized to avoid fatigue effects. Peak concentric force, rate of force development, impact force, and time of the jumps were determined using a force plate.

RESULTS: Peak concentric force and rate of force development were significantly (P < 0.05) higher in the aquatic jumps, whereas impact force was significantly (P < 0.05) lower. There was a shorter total jump time (P < 0.05) for the aquatic jump without devices, whereas the time required to reach peak force was not significantly different between the two environments, despite the greater resistance to movement in the aquatic medium.

DISCUSSION: Aquatic jump exercises result in greater force production and rate of force development in the same amount of time with less impact and can thus offer a viable alternative to traditional dry-land jump exercises, which may also be beneficial for rehabilitating or aging populations. The benefits of this type of exercise include an exercise mode that can be performed without compromising speed while reducing the potential for joint injury.

Department of Health, Leisure, and Exercise Science, Appalachian State University, Boone, NC, USA. triplttnt@appstate.edu

The Navy brings water aboard... for therapy

Last year, the Navy was looking for a way to increase career longevity of its special warfare combatant-craft crewman (SWCC) and SEALS.

It turned to water for the answer.

The Navy recently added a therapy pool to its inventory of equipment used to prolong a special boat operator's career.

The program is modeled after similar programs used by professional sports organizations, such as the National Football League. Its primary goal is to prevent or heal the damage done to a SWCC or SEAL's body simply because of the nature of his or her daily duties.

The pool is 15 feet long by 7 feet wide and is 4 1/2 feet deep. It holds approximately 2,000 gallons of water and has two high-powered water jets that push water over a built-in treadmill to provide different degrees of resistance.

Source: "Navy Integrates Hydrotherapy into Physical Fitness Program". NavySeals.com

Treadmill walking versus deep water running in overweight women: Which is harder?

Phillips VK, Legge M, Jones LM. Maximal physiological responses between aquatic and land exercise in overweight women. Med Sci Sports Exerc. 2008 May;40(5):959-64.

School of Physical Education, University of Otago, Dunedin, New Zealand. vicky.phillips@otago.ac.nz

PURPOSE: To investigate the maximal physiological responses between aquatic and land-based graded exercise tests in overweight women.

METHODS: Twenty healthy, overweight (body mass index (BMI) > or = 25 kg.m(-2)), Caucasian women (mean +/- SD; age 48 +/- 7 yr, BMI 30 +/- 4 kg.m(-2)) completed a deep water running (DWR) and treadmill walking (TMW) graded exercise test.

Maximal responses during the DWR and TMW graded exercise tests were compared using paired t-tests.

Comparisons were made in the incidence of achievement of maximal oxygen consumption (VO2max) criteria between DWR and TMW protocols.

Criteria were a plateau in VO2 (change < 2.1 mL.kg.min(-1)), heart rate (HR) equal to or above the age-adjusted maximum, and respiratory exchange ratio (RER) > or = 1.15.

RESULTS: Maximal responses for VO2max (22.5 +/- 4.86 vs 27.7 +/- 4.73 mL.kg.min(-1)), HRmax (159 +/- 16 vs 170 +/- 12 bpm), and RER (1.03 +/- 0.06 vs 1.10 +/- 0.06) were significantly lower (P < 0.01) for the DWR test compared with the TMW test, respectively.

Achievement of various VO2max criteria was demonstrated more consistently during the TMW test than the DWR test.

CONCLUSION: Maximal physiological responses of overweight women to DWR and TMW are significantly different but are comparable with other populations. As the maximal responses for DWR compared with TMW differ, the use of land-based criteria for VO2max is not recommended for a graded DWR exercise test.

Another nail in the coffin of the only-weight-bearing-exercises-will-improve-bone-density theory

You've heard the conventional wisdom. Aquatic exercise is nice, but what about bone loss? Only weight-bearing activities can retard (and even reverse) bone loss. Right?

Hmmm. Well someone better tell these guys, soon.

Rotstein A, Harush M, Vaisman N. The effect of a water exercise program on bone density of postmenopausal women. J Sports Med Phys Fitness. 2008 Sep;48(3):352-9.

Department of Life Sciences, Zinman College, Wingate Institute, Netanya, Israel. rotstein@wincol.ac.il

AIM: The aim of the present study was to examine the effect of a seven months program of water exercise, on bone mineral density (BMD) in postmenopausal women.

METHODS: Thirty-five postmenopausal women trained for seven months for three one-hour sessions per week. DEXA test findings for vertebrae L2-L4 showed that although the time factor had a significant effect only on the bone mineral content (BMC), (4.61 P < 0.05), the interaction of time group was found to be significant for each of the variables: BMD (9.25 P < 0.01), BMC (7.99 P < 0.01), z-score (5.35 P < 0.05) and t-score (9.41 P < 0.01).

RESULTS: These interactions indicate a general trend towards maintenance or improvement of bone status in the experimental group and a trend towards declining bone status for the control group. DEXA test findings for femoral neck density indicated no significant differences between the groups pre and post treatment. However a significant interaction was found for BMC (8.08 P < 0.01) in the right leg indicating an increase trend in BMC in the experimental group and a trend towards decrease for the control group.

CONCLUSION: The findings of the present study support the hypothesis that it is possible to plan and execute a water exercise program that has a positive effect on bone status of post-menopausal women.

Ask ARN: Does aquatic therapy effect bone density in patients with osteoporosis or osteopenia?

The Aquatic Resources Network gets questions from clinicians each day. We think everyone should learn from the answers!

Question: How does aquatic exercise or therapy effect bone density? It would seem that the reduction in weight-bearing which occurs with water-based exercise would diminish the benefits for bone retention.

Answer: The answer is two-fold. Yes, exercising in the pool will reduce the amount of joint compression and weight-bearing performed during a given task (isn't that what we love about aquatic exercise?).

Thus, a given gravity-based task "should" result in greater bone preservation (and perhaps even growth) than its water-based cousin.

However, weight bearing is not the only way to lay-down (or preserve) bone. Strength training exercises, which cause the muscles of the body to pull on their respective bones, can also effect bone density. And aquatic exercise has been shown to create enough pull to have a positive effect on bone.

Bibliography on bone density, body composition and aquatic exercise...

Here is the conclusion of one study addressing this very issue:

Ay et al (2005): Although weight-bearing physical activity is known to be superior to non-weight-bearing activity to increase the bone mass, our present evidence shows that aquatic and weight-bearing exercises both can increase calcaneal BUA.

More studies are listed in the bibliography provided above.

ACL rehabilitation through aquatic therapy: A good idea or dangerous for the knee?

Are you taking your anterior cruciate ligament (ACL) patients in the water? If you are treating a partially torn ACL — or a reconstructed ACL — you will want to follow some restrictions. For instance, you will need to avoid some elements of open chain terminal knee extension. In other words, you need to avoid resisted knee extension for the last 30 degrees of extension.

So, what does this mean for treatment?

Do not put your patient in a resistance boot (or a flipper or fin) and then have the person rapidly flex and
extend against the resistance of the water.

Why would this be a concern? What benefits would water therapy add to the mix?

Find out more (PDF)...

Adapted scuba diving for disabled veterans

Thanks to a program at Walter Reed Army Medical Center, disabled soldiers are learning to scuba dive and explore the wonders of our undersea world. Known as "SUDS" (Soldiers Undertaking Disabled Scuba), the innovative training and certification program is helping wounded warriors from Iraq and Afghanistan to experience life from below sea level.

"It's the most rewarding project I have ever been involved in," says John W. Thompson, president of the SUDS board of directors. He's a certified diving instructor who sees the ocean as a great equalizer.

"Many things are just easier to do in the water with these types of injuries," he says. To prepare himself for the task of teaching severely wounded soldiers how to dive, Thompson enrolled in a training program in Florida offered by the Handicapped Scuba Association.

Thompson describes SUDS, which launched in February 2007, as "part rehabilitation, part confidence-building (and) part adventure for these wounded warriors. I'm really inspired by the soldiers at Walter Reed."

Read more on this story...