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Is Aquatic Therapy for Spinal Cord Injury More Effective Than Traditional Exercise?

spinal cord injury patient practicing aquatic therapy exercises with PT

There are several properties of water that can help spinal cord injury patients improve their mobility, especially as a supplement to traditional physical therapy.

Aquatic therapy is a type of physical therapy that involves practicing exercises in a pool. It can be an effective way for SCI patients to develop their balance, strength, and movement patterns.

To help you determine whether aquatic therapy is worth trying, this article will go over its techniques, benefits, and risks.

Aquatic Therapy Exercises for Spinal Cord Injury

There are a wide variety of aquatic therapy techniques. Some focus on developing balance, while others emphasize speed or strength.

Depending on your functional abilities, certain techniques may be more ideal than others. A physical therapist will guide you through the exercises and suggest adjustments as necessary.

The most widely practiced aquatic therapy techniques include:

  • Bad Ragaz Ring Method: This method involves having patients float on their back while wearing floating rings around their neck, arms, torso, and ankles. They are then guided through various exercises designed to expand range of motion and promote body awareness.
  • Halliwick Method: This method consists of exercises that focus on developing balance, posture, and motor control. It emphasizes that it’s okay to lose balance as long as you try to get up again.
  • Watsu: This is a passive form of aquatic therapy, meaning that the patient does not have to exert any effort. Instead, the physical therapist will move the patient’s body for them in warm water. It involves cradling, stretching, and massaging the body to relieve muscle tightness and increase range of motion.
  • Aqua Jogging: This technique involves wearing floatation vests to help patients stand upright while jogging or walking. The reduced impact on the joints helps spinal cord injury patients focus on improving their form.
  • Burdenko Method: This method focuses on developing balance, coordination, flexibility, endurance, speed, and strength by using specialized equipment like floatation vests, water barbells, resistance bands, and boards.
  • Ai Chi: Ai Chi focuses on deep breathing and balance through slow, controlled movements underwater. It’s a relaxation technique that promotes fluid movements and helps reduce stiffness in connective tissues.

Now that you understand what types of exercises are involved in aquatic therapy, let’s discuss the unique benefits of being submerged in water.

Benefits of Aquatic Therapy for Spinal Cord Injury

physical therapist guiding spinal cord injury patient through aquatic therapy exercises

There are several inherent properties of water that can promote mobility in ways that cannot be reproduced on land.

Below, we’ll discuss 5 major benefits of aquatic therapy for spinal cord injury recovery.  

1. Reduces Pressure on the Joints

Buoyancy is the upwards force exerted by water that counteracts gravity, keeping you afloat and feeling light.

It relieves pressure off of the joints and with less weight to bear, the easier it is for spinal cord injury patients to focus on balance and correct their gait.

The deeper the body is submerged in water, the lighter you will feel. Spinal cord injury patients can increase the difficulty level of their exercises by moving into shallower water. Over time, this will help accustom the joints to bearing more weight, with the goal of patients progressing towards walking on their own.

2. Strengthens the Muscles

Another property of water that can help promote spinal cord injury recovery is drag force, the resistance of a fluid against an object in motion.

The resistance of water is greater than that of air, which is why movement for the same amount of energy is slowed down in water.

In order to maintain normal speed underwater, the muscles must exert more effort, which develops strength. Stimulating the muscles helps increase endurance, reduce the hyperactivity of spastic muscles, and maintain full range of motion.

3. Promotes Body Awareness

The slow-moving environment of a pool caused by drag force promotes proprioception (body awareness in relation to space) by providing more time for patients to think about and react to their movements.

The resistance of water also creates a safe rehabilitative environment as it minimizes the impact of a fall. This will help reduce the fear of falling and encourage SCI patients to more actively participate in their exercises.

4. Relieves Pain

Hydrostatic pressure is the force of water on the body from all directions. It provides constant compression and when paired with heat from the warmed pool, can stimulate the nerve endings to block pain signals.

Compression and heat also promote circulation, which enables more efficient delivery of oxygen and other essential nutrients necessary to relax tight muscles and promote healing.

5. Increases Self-Confidence

Spinal cord injury rehabilitation is both a physical and mental challenge. Having the motivation to repetitively practice weakened movements is essential because thousands of repetitions are required to stimulate neurological adaptations in the spinal cord.

By combining the five benefits of aquatic therapy listed above, patients can perform movements in water that they may not be able to on land. Increased mobility can help boost their confidence and motivation to perform the repetitions they need to promote recovery.

Is Aquatic Therapy Safe for All SCI Patients?

While aquatic therapy can be beneficial for spinal cord injury rehabilitation, it may not be ideal for all SCI patients. Everyone experiences different variations of spinal cord injury secondary effects, so special considerations must be made to ensure aquatic therapy is a safe option for them.

For example, SCI patients with pressure sores should avoid getting into a pool because moisture increases the risk of infection and makes the skin more susceptible to breakdown.

Similarly, those with injuries at T6 and above who are at risk for autonomic dysreflexia may experience difficulties with body temperature regulation. Being in a heated pool while exercising can cause overheating and result in hypertension, arrythmia, or fever.

Your physical therapist may also be able to offer suggestions for managing complications in the water. For example, individuals with bowel and bladder dysfunction should perform their bowel programs prior to getting into the pool and make sure that the openings of their catheters are secure to avoid leaking.

Understanding Aquatic Therapy for Spinal Cord Injury

Aquatic therapy can be an effective way for spinal cord injury patients to develop their motor skills.

Not only does it reduce the impact of gravity on the joints, but it also tones the muscles, relieves pain, and promotes body awareness.

By gradually reducing how much of the body is submerged in water, the joints can practice bearing more weight. This will help ease the transition onto land.

Hopefully, this article helped you understand how aquatic therapy can help improve mobility after spinal cord injury. Good luck!

Photos from top to bottom: iStock/Ridofranz/Ridofranz

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