PT Tip of the Month Archive

Aquatic Therapy

Aquatic therapy is a type of physical therapy or exercise using the resistance of water in a pool. These kinds of exercises can be helpful in improving strength, cardiovascular endurance, flexibility, function, balance, and general fitness. Additionally, warm water can help to increase range of motion and flexibility. Participants can walk, run, jump, or swim and all of these exercises can be non weight bearing due to the properties of water, therefore taking unwanted stress and strain off of achy or painful joints.



Many people enjoy exercising in water because the water helps support their body weight, decreasing stress and strain on joints and resulting in less pain. This phenomenon is known as buoyancy. Buoyancy is defined as the upward force against gravity when an object is placed in water. The deeper you are in water the greater buoyancy will affect your weight and decrease the shock of impact on your bones, joints, and ligaments. A recent study published in the Journal of Orthopedics & Sports Physical Therapy found that running in water that is hip level can decrease the bodies force caused by gravity by about 40%. When in chest deep water the forces decrease even more to about 50% while at the neck level it decreases by 90%. If floating, or fully submerged in water, there is zero impact on our joints, fully removing these stresses. Those who have weight bearing restrictions or are not fully comfortable putting weight on their legs due to surgery or injury, have low back pain, are pregnant, or those with chronic pain, such as fibromyalgia, find these effects of buoyancy a welcome benefit.

Water Resistance

Water also can provide a fair amount of resistance to assist in strengthening. As you move a limb or your body through water, your body has to push the water out of the way, therefore slowing your motion down. The quicker you push through the water, the greater the resistance. Water resistance can assist with posture, strengthening, core stabilization, and balance when performing aquatic therapy. Research also shows that water resistance helps to improve sensory awareness which will also help to improve balance.


Hydrostatic Pressure

Hydrostratic pressure is the force applied to the body by the pressure of fluid. This pressure is exerted equally on all parts of the body at rest at a given depth. Hydrostatic pressure can assist with return of blood to the heart, allowing it to work more efficiently. This effect can also reduce swelling in limbs, particularly the feet and ankles. As joint swelling decreases, individuals may feel improvement in joint pain or tenderness, range of motion, and therefore activity tolerance. It should be noted that hydrostatic pressure applies a mild resistance against the rib cage. Breathing with the trunk fully immersed in water can be an exercise within itself for those with respiratory dysfunction and should therefore be approached with caution. If you are someone who has significant respiratory dysfunction, consider consulting your doctor before engaging in deep water exercises.

Water Temperature

Pool temperature can affect exercise tolerance. While water temperature is a personal preference, recommended temperatures for aquatic therapy range from 85 degrees to 94 degrees Fahrenheit. Cold water can decrease exercise tolerance and tap energy quickly as your body works harder to stay warm. Warm water can help to relax muscles, however excessively warm water should be avoided to prevent overheating.


Medical clearance may be required in many cases prior to beginning water based exercising. Those with cardiac or respiratory dysfunction should consult a doctor prior to starting. Those with recent surgeries should hold off from getting in a pool until your incision is fully healed to prevent risk of infection. Furthermore, those with skin rashes, other open wounds, sores, or infections should also withhold from this activity. Allergies to pool chemicals or urinary and bowel incontinence should also be considered. It is also safer to have someone present in the pool area with you in case of emergency. Surfaces around the pool tend to be slippery and use of railing, steps, or ramps should be used for those with risk of fall. If the pool is outdoors, sun exposure should be considered as this can further deplete your energy or tolerance for exercise.

It may take time to acclimate to the feeling of exercising in water. It is advised to start with 15-20 minutes of exercise to determine how well your body tolerates a new form of exercise. While exercising, remember to breathe normally. Counting out loud is a good strategy to avoid holding your breath. Completing exercises with correct form and posture is also important to prevent exercise related injury. It is always better to do fewer repetitions with proper technique and control than many repetitions and sets with poor form. Lastly, aquatic therapy and swimming is an exercise and depletes our bodies fluids, so it is important to stay hydrated.

If you think you are experiencing an injury that you feel may benefit from aquatic therapy and would like to be scheduled for a physical therapy evaluation, please contact 617-232-PAIN (7246) for our Brookline office and 617-325-PAIN (7246) for our West Roxbury office. Beantown Physio unfortunately does not have pool access, however we are happy to supplement your home exercise program with aquatic exercises for those with independent access to a pool, if appropriate.


  1. De brito fontana H, Haupenthal A, Ruschel C, Hubert M, Ridehalgh C, Roesler H. Effect of gender, cadence, and water immersion on ground reaction forces during stationary running. J Orthop Sports Phys Ther. 2012;42(5):437-43.
  2. Alberton CL, Cadore EL, Pinto SS, Tartaruga MP, Da silva EM, Kruel LF. Cardiorespiratory, neuromuscular and kinematic responses to stationary running performed in water and on dry land. Eur J Appl Physiol. 2011;111(6):1157-66.
  3. Gibson AJ, Shields N. Effects of Aquatic Therapy and Land-Based Therapy versus Land-Based Therapy Alone on Range of Motion, Edema, and Function after Hip or Knee Replacement: A Systematic Review and Meta-analysis. Physiother Can. 2015;67(2):133-41.
  4. Schaefer SY, Louder TJ, Foster S, Bressel E. Effect of Water Immersion on Dual-task Performance: Implications for Aquatic Therapy. Physiother Res Int. 2015.
33 Pond Avenue, Suite 107B Brookline, MA 02445 Tel: (617) 232-PAIN (7246) Fax: (617) 232-5196
1208B VFW Parkway, Suite 202 West Roxbury, MA 02132 Tel: (617) 325-PAIN (7246) Fax: (617) 325-7282