Aquatic Therapy: Let Water Help You Move, Heal, and Get Stronger

By Dr. John Mishock, PT, DPT, DC 

For many people dealing with arthritis, back pain, joint replacement, injury, or chronic pain, there is a frustrating problem: exercise may be exactly what they need, but pain makes exercising difficult.

Aquatic physical therapy can help bridge that gap.

Aquatic therapy is physical therapy performed in a therapeutic pool under the direction of a physical therapist. The unique properties of water allow patients to move, strengthen, and exercise while placing less stress on painful joints and tissues. Instead of simply resting until the pain disappears, aquatic therapy can provide an environment where rehabilitation can begin earlier and progress toward more challenging land-based exercise.

Why Does Exercising in Water Help?

Buoyancy decreases the amount of body weight that joints and muscles must support. This can make walking, squatting, stepping, strengthening, and range-of-motion exercises more comfortable for someone who struggles to perform those same movements on land.

Water also provides resistance in virtually every direction. The faster or harder you push against the water, the greater the resistance becomes. This gives the physical therapist an excellent tool for gradually increasing strengthening exercises based on the patient’s tolerance.

In addition, the pressure of the water around the body, known as hydrostatic pressure, may assist with swelling while the warm-water environment can make movement more comfortable for stiff or painful joints.
The goal isn’t simply to “float around in a pool.” Aquatic therapy is a structured rehabilitation program designed around the patient’s diagnosis, limitations, and functional goals.

What Does the Research Say?

The evidence supporting aquatic exercise continues to grow. In a large 2023 systematic review and meta-analysis, Wang and colleagues analyzed 32 randomized clinical trials involving 2,200 patients with chronic musculoskeletal disorders. Published in the Journal of Orthopaedic Surgery and Research, the researchers found that aquatic exercise significantly improved pain, physical function, and quality of life compared with no exercise. Aquatic exercise also produced greater pain improvement than land-based exercise in their pooled analysis.

Research is particularly encouraging for people with arthritis. Xu and colleagues published a 2023 systematic review and meta-analysis in Clinical Rehabilitation involving 22 studies and 1,394 people with knee osteoarthritis. Aquatic exercise significantly improved pain, stiffness, and physical function compared with no exercise. Importantly, no serious adverse events related to aquatic exercise were reported in the studies reviewed.

Aquatic therapy may also be particularly valuable for people with persistent low-back pain. In a randomized clinical trial published by Peng and colleagues in JAMA Network Open in January 2022, 113 adults with chronic low-back pain were assigned to therapeutic aquatic exercise or physical therapy modalities. The aquatic exercise group experienced greater improvements in disability, pain, quality of life, sleep quality, and fear of movement, with some benefits persisting through the 12-month follow-up.

That does not mean aquatic therapy is automatically superior to land-based physical therapy for every patient. In many conditions, research shows both approaches can be effective. Clinically, the real power of the pool may be that it allows a patient who cannot yet tolerate sufficient exercise on land to start moving, strengthening, and rebuilding confidence sooner.

Who May Benefit?

Aquatic physical therapy may be especially helpful for people recovering from joint replacement or orthopedic surgery, as well as those experiencing osteoarthritis, low-back pain, hip or knee pain, difficulty walking, weakness, deconditioning, balance limitations, chronic pain, or an injury that makes conventional exercise painful. At Mishock Physical Therapy & Associates in Gilbertsville (610-327-2600), we have an aquatic therapy program specifically designed to incorporate the benefits of water into individualized physical therapy.

Our philosophy is simple: reduce pain, restore movement, rebuild strength, and progress patients toward the highest level of function possible. For some patients that process begins on land. For others, the best starting point may be in the water.

At Mishock Physical Therapy, our philosophy is simple:

Treat the problem early. Restore movement. Build strength. Keep people active. Escalate care when it is medically necessary. When appropriate, start conservatively. Start actively. Try physical therapy first.

We can help!

If pain is limiting you from doing the activities you enjoy, give Mishock Physical Therapy a call: locations in Gilbertsville (610-327-2600), Skippack (610-584-1400), Phoenixville (610-933-3371), Boyertown (610- 845-5000), Limerick (484-948-2800)  at www.mishockpt.com or request your appointment by clicking here.

Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. He has also authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon or train2playsports.com.