aquatic therapy and the healing power of exercise

1. Aquatic Therapy and the Healing Power of Exercise Presented by Maureen Hagan Physiotherapist BA PE (Physical Education) 2006 IDEA Fitness Instructor & 1998 IDEA Program Director of the Year

3. Objectives of Therapy/Therapeutic Exercise� Decrease pain and swelling and disability, Restore function, physical performance & quality of life, Retrain or enhance kinesthetic awareness and life skills, Train specific for sport or occupation to prevent future injury or re-occurrence, Decrease rehabilitation time.

4. To Heighten Awareness of the Onset of Injury� Repetitive motion that may be forceful and,or stressful Poor posture Poor movement mechanics/patterns Overuse ? Leads to repetitive strain injury Inactivity Sedentary living Regular participation in exercise and sport *Aging Accumulative over time

5. The Onset of a Injury� The body becomes depleted of energy stores (common in strenuous exercise bouts) and trauma results due to damage to tissues, As energy is depleted at a cellular level during exercise or repetitive movement, fatigued tissues can no longer maintain the proper positioning associated with good mechanics. This focuses stress in certain areas and this increases the chance of damage to those tissues (both acute and chronic). If one does not recover from a bout of strenuous exercise, they will not be ready for the next bout and an accumulation of deterioration (lack of recovery) and performance begins to lag. This is the human injury cycle.

6. Common Sites for Injury to Occur� INJURY CAN OCCUR IN: 1. Muscle/Tendon- damaged and scar tissue or imbalance of muscle. 2. Joint- abnormal motion of a joint or joint has become unstable due to ligament stress/injury. 3. Nerve- tension or compression? decrease in power to nerve. 4. Biochemical- if over-trained or deficient in specific nutrients ? global decrease in strength which may compound the problem.

7. Most Common Conditions that Benefit from Aquatic Therapy Exercise� Osteoarthritis Rheumatoid Arthritis Fibromyalgia Frozen Shoulder Stress Fractures Joint Replacement Muscle Skeletal Injuries Others include:

8. Add Further Insult by: Poor Posture Poor Movement Mechanics/Patterns Poor Conditioning/Fitness level Over Training/Chronic Injury Poor Instruction/Supervision Poor Nutrition Genetics

9. THINK Outside Your Box... Aqua Therapy/Exercise is Ideal for the Following Reasons: Working in Aquatic Therapy/Exercise is Beneficial for the Following Reasons:

10. Magical Properties of Water: Resistance- ++ work Turbulence- fitness at all levels Thermal Conductivity- 82-89� ideal Buoyancy- �great equalizer� Hydrostatic Pressure-circulatory effect* Resistance- double positive (concentric contraction), reduced DOMS response to exercise Turbulence- HR and cardio response, strength; training effect/integrates fitness components Thermal Conductivity- water temperature dissipates heat; cooling response. Temperature needs to be minimum of 82 degrees and 89 degrees for aquatic therapy. Buoyancy- stabilization and cross training effect and great equalizer for land based training (anti-gravity muscles) Hydrostatic Pressure- effect on circulation; respiration; fluid balance (kidneys), vital capacity and HR Resistance- double positive (concentric contraction), reduced DOMS response to exercise Turbulence- HR and cardio response, strength; training effect/integrates fitness components Thermal Conductivity- water temperature dissipates heat; cooling response. Temperature needs to be minimum of 82 degrees and 89 degrees for aquatic therapy. Buoyancy- stabilization and cross training effect and great equalizer for land based training (anti-gravity muscles) Hydrostatic Pressure- effect on circulation; respiration; fluid balance (kidneys), vital capacity and HR

11. Benefits of Aqua Exercise/Therapy� Properties of: Resistance- Impose 3-demensional/multi planar movement ideal for re-training, restoring function: strength, endurance, stability, ROM, mobility; reduces DOMS Turbulence- Alter intensity as required which can accommodate variety of needs (by adjusting surface area); increases fitness/intensity, cross training effect Hydrostatic pressure- Decrease swelling, decrease stress on cardiac, increases respiratory demands which requires consideration, positive effect on swelling, lymphatic drainage, fluid balance (kidneys) Buoyancy- increases joint space Assists ROM, decreases joint compressive forces, increases joint space and reduces pain and stiffness; complements land training (anti-gravity forces) Thermal Conductivity- Assists with circulation, muscle properties (tension, elasticity), joint and tissue pain and stiffness *IF TEMPERATURE IS OPTIMAL FOR THERAPY. May impose challenges for rehabilitation participants. Ideal is 89 degrees (minimum is 82�)

12. Benefits of Aquatic Therapy/Exercise� IDEAL Conditions: Improves on fitness components including joint stability & mobility Decreases joint and tissue pain & stiffness Increases muscle elasticity and balance (anti-gravity muscles) Decreases muscle spasm, tension & DOMS Increases vital capacity, circulation & venous return Decreases impact stress on weight bearing joints Improves fluid balance and lymphatic drainage Others:

13. Dr Bernie Seigel� �The emotional environment we create in our bodies can activate mechanisms of destruction or repair�

14. Chronic Disease Cycle�

15. Practical Programming Considerations... Aquatic environment must be inviting for clients: ideal water temperature is 84-89 degrees F (27-31 degrees C), 30-60 minutes in length consisting of a warm-up (5-7), ROM (5-7 min) specific to joints/tissues involved as well as general, C-V exercise (5-10 min), MSE* (10-30 min) including isometric, isotonic in a slow, controlled manner encouraging full ROM as tolerated utilizing buoyancy to assist, Recovery (socialize, evaluate and revitalize) as required, Low to moderate intensity aerobic conditioning- 2 hour window to measure intensity/training tolerance, 2-3 times per week recommended- progress to 5 days a week to include land based programming.

16. Training Tips and Recommendations... Seek the client�s Dr or medical professional�s guidance about your mutual client. Assess habits outside the gym; factors that + and - �ly influence. Assess history & quality of exercise program prior to your supervision. Assess quality of functional vs. isolated strength, flexibility, muscular endurance, muscle balance and posture. Integrate function utilizing multi-joint movements that require balance and stability, Also offer feedback, options/modifications, coach and communicate with empathy; self-check style Listen to your client and assess visual cues (teach from the deck) Never diagnose or prescribe treatment (limited to R.I.C.E) Recommend ongoing medical supervision. Promote general activity/exercise (however modified)is recommended for most all conditions described in this seminar for the benefits associated with regular physical exercise. Train the joint above and below the affected joint/area to positively stress the joints and muscles (proprioception and reaction skills) Focus on strengthening the weak for improving function and the tight/inflexible will often take care of themselves.

17. Training Tips and Recommendations� Offer/introduce exercise options in the warm-up and cool down so participants can prepare and recover effectively Teach according to sound principles of training; including functional to address ADL�s in addition to fitness/sports goals and objectives Incorporate posture and alignment checks throughout training Offer options to all recognizing unique differences Avoid repetition and ensure balance in muscle group training Educate participants Teach/empower participants to listen to their body and recognize signs of fatigue, muscle soreness and even structural changes (red flags) �Trial and Error� one thing at a time and re-evaluate outcome. Do not ignore �innocent signs/symptoms� Put up a red flag Never diagnose and prescribe Rx- prevention and management Never think you know it all. Consult with others Follow up

18. In Closing... As we embark on the quest to promote Physical Activity to everyone, the Fitness & Aqua Professional is responsible for recognizing and understanding the post- rehabilitation exercise process. How do/will you �fit in�?

20. References available upon request. GREAT Resource for Functional Programming ideas: �FIT-iology- the study of Fitness in Action� by Maureen Hagan, BScPT, BA PE *Volume II will be available August 14th at Can-Fit-Pro Durrett, April �Opportunities in Postrehab, IDEA Personal Trainer, June 2002 *Great article for those interested in creating or developing their business Ball, Daniel �The Psychology of Sport and Exercise Injury�, IDEA Health & Fitness Source, March 2002 *Great for developing a better understanding of how their client(s) is adapting during injury CALA- Canadian Aqua Leaders Alliance training manual For more information on workshops� contact Maureen at: The GoodLife Fitness Clubs (in Canada) by email: mo@goodlifefitness.com or phone at 1800-790-9269 ext 245 or on her own website: www.mohagan.com